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�Commonwealth of Massachusetts. Penobscot, ss. On the 18th day of May A.D. 1818, before me the subscriber, one of the Judges of the Third Eastern Circuit, of the Court of Common Pleas, in said Commonwealth, including the Counties of Hancock, Washington and Penobscot : Personally appeared Francis W. Appleton who, being by me first duly sworn according to law, on his oath made the statement and declaration by him subscribed, and hereto annexed, in order to obtain the provision made by the late 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."

    And, thereupon, I the said Judge do certify that I am satisfied the said Francis did serve in the revolutionary war, as stated in his said declaration, against the common enemy, and that he has made it appear to me, that he is in reduced circumstances, and stands in need of the assistance of his country for support.
    Which proceedings and the testimony annexed, being all he has been able to produce, I now transmit to the Secretary, for the department of War, pursuant to the directions of the aforementioned act of Congress.
    In testimony whereof, I have hereunto set my name and caused the seal of said Court to be hereto affixed.

M. Hinsley Esquire, Judge of the Court as aforesaid.