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� [the following is a pre-printed form with handwritten insertions, deletions, oaths and schedules]

STATE OF MAINE COUNTY OF PENOBSCOT, ss Circuit Court of Common Pleas begun + holden at Bangor in + for said County on the third Monday of Sept A.D. 1820 [handwritten]

On this 20th [handwritten] day of September [handwritten] in the year of our Lord eighteen hundred and twenty, personally appeared in open court, being a court of record within and for said County and the State of Maine, established by a law of the Commonwealth of Massachusetts, made and passed on the eleventh [stricken] 21st [inserted] day of June, A.D. 1811, and recognized by the Constitution of the State of Maine, William Davis [handwritten] aged fifty seven [handwritten] years, resident in Eddington [handwritten] in said County of Penobscot, who being first duly sworn according to law, doth, on his oath declare that he served in the Revolutionary war as follows:

[handwritten] that in the year 1781 he enlisted into the United States service as a private soldier, in the month of January he joined the ninth Mass Regt at West Point, in the State of New york commanded by Col. Jackson in Capt. Walkers Company I served in this [Company - stricken] Regiment until it was disbanded in 1782 and being a 3 years man was transported into the 2nd Regt Mass'tts Line Commanded by Col Sprout into a company commanded by Capt Ballard. In this Regt I served until Sept 1783 + then was discharged my discharged was signed by Gen'l Knox. I never was in any Regular Battle: but in several skirmishes. I am by occupation a farmer + owing to infirmity of body am incapable of attaining a living by my labor: having never performed a days work in a day for seven years past; I made my original declaration before Martin Kinsley Esq on the 4th day of April 1818.

And I William Davis [handwritten] do solemnly swear that I was a resident citizen of the United States on the 18th day of March 1818; and that I have not since that time by gift, sale, or in any manner disposed of my property, or any part thereof, with intent thereby so to diminish it as to bring myself within the provisions of an Act of Congress, entitled "An Act to provide for certain persons engaged in the land and naval service of the United States, in the Revolutionary War," passed on the eighteenth day of March, one thousand eight hundred and eighteen; and that I have not, nor has any person in trust for me, any property or securities, contracts, or debts due to me; nor have I any income other than what is contained in the schedule hereto annexed, and by me subscribed. Wm Davis [signature]

Sept'r Term of C.C.C. Pleas A.D. 1820 Sworn to + declared in Court

[following is stricken by pre-printed form] I, THOMAS COBBE, Clerk of the Circuit Court of Common Pleas, for the Third Eastern Circuit in the County of Penbscot and State of Maine, do hereby certify that the foregoing [blank] and the schedule thereto annexed, are truly copied from the records of the said Court: And I do further certify, that it is the opinion of the said Court, that the total amount of the property exhibited in the aforesaid schedule is [blank] dollars and [blank] cents. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of the Court on this [blank] day of [blank] A.D. 1820 Clerk of the said Court for the County of Penobscot

[handwritten] Penobscot C.C.C. Pleas at Bangor September Term A.D. 1820 And now, after mature consideration, the Court is of opinion, that the total amount in value of the property exhibited in aforesaid schedule is three hundred thirty seven dollars. Att Thos Cobbe Clerk