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State of Maine Penobscot Ss On this twenty sixth day of June A.D. 1823 personally appeared in open Court being the [stricken] Court of Common Pleas, the same being a court of Records which have [?] according to the course of the common law with unlimited discretion as to [clause inserted between lines] and holden at Bangor is and for the County aforesaid on the fourth tuesday of June A.D. 1823 [clause stricken] Amos Dole of Orrington in said County age sixty six years next September who being first duly sworn according to law doth on his Oath made the following declaration in order to obtain the provision made by the Act of Congress at the 18th of March 1818 and the first of May 1820 and first of March 1823 [clause inserted] that the said Amos Dole enlisted for the term of three years["three years" underlined] in the Spring of the year 1777 in the State of Massachusetts in the Company commanded by Capt Sylvanus Smith in the Regiment commanded by Col Timothy Bigelow in the line of the State of Massachusetts in the Continental establishment; and he continued to serve in said Corps until the end of Said term and receive an honorable discharge - and again en-listed in the same company in the month of May or June in the year 1780 for three years ["three years" underlined] and served till May 1783, when he was discharged from Said Service at West Point in the State of New York, that his name has been placed on the Pension List, and struck there from an account of his property.

And in pursuance of the act of the first of May 1820 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 discharged of my property or [stricken] any part thereof with intent thereby 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 18th Day of March 1818. And that I have not now have or has any person in trust for me, any property, or security, contracts or debts due to me or have I any income other than what is contained in the Schedule hereunto annexed, and by me subscribed as exhibited in my Schedule made on the 27th Day of June A.D. 1820, a copy of which has been duly forwarded to the Secretary of War, viz:

Real Estate. I have none. Personal Estate - 1 horse and sleigh - 1 cow - 1 2 year old Heifer - 2 swine - 1 old Plough and Harrow - 6 sheep (all valued by the Court at Ninety two Dollars) That I am one hundred and fifty dollars and am liable to be pursued for payment (over)