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[typed form with handwritten insertions]

�State of Maine. KENNEBEC COUNTY, ss. ON this Fifteenth[handwritten] day of [stricken] August[handwritten], 1820, personally appeared before Josiah Stebbins esq.[handwritten] Justice of the Circuit Court of Common Pleas, for the Counties of Lincoln, Kennebec and Somerset, being a Court of Record for said Counties, proceeding according to the course of the common law, having original jurisdiction, unlimited in amount, keeping a record of their proceedings, and being the power of fine and imprisonment, Daniel Johnson[handwritten] aged fifty six[handwritten] years, resident in Belfast[handwritten] in the County of Hancock now of Augusta[handwritten] within said Circuit, who being first duly sworn according to law, doth, on his oath, declare that he served in the Revolutionary war as follows, viz. in the Company commanded by Captain Farewell[handwritten] and Regiment commanded by Colonel Kelly[handwritten] of the line of the State of New Hampshire[handwritten] upon the Continental Establishment, for the period of nearly eleven months[handwritten] that his original declaration was made before Judge Crosby[handwritten] on the eleventh[handwritten] day or April[handwritten] 1818; that he is now on the Maine Roll and that his pension certificate is numbered 13194[handwritten]. And I, the said Daniel Johnson[handwritten] do further solemnly swear, that I was a resident of the United States, on the eighteenth day of March, one thousand eight hundred and eighteen