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� [the following is a pre printed form with handwritten notes and schedules, handwritten will be noted]

STATE OF MAINE[header]

COUNTY OF PENOBSCOT, ss At a[handwritten] Circuity Court of Common Pleas begun and holden at Bangor within and for said County on the fourth Tuesday of June A.D.1820[handwritten]

On this twentyseventh[handwritten] day of June[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 State of Maine, having the right of fine and imprisonment[handwritten insertion] established by a law of the Commonwealth of Massachusetts, made and passed on the eleventh[stricken] twentyfirst[handwritten] day of June A.D. 1811, and recognized by the Constitution of the State of the Maine, Samuel Bailey[handwritten] aged fifty eight[handwritten and stricken] 64 years, resident in Sundahayes[?] Plantation, 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] viz. in the year 1777 I inlisted for three years and served during that time as a musician under Captain Benjamin Buxton and under Captain Joshua Trafton[?] in the Regiment commanded by Colonel Henry Thornburn[?] and Colonel Henry Jackson and at the exhaustion of said time was honorably discharged. I served three other years in the Revolutionary War and not on the Continental Establishment - all which will appear by my original declaration made on the twentysecond day of April A.D. 1818 on which declaration my certificate of pension numbered 9.166[?] was granted.

I served in Bunker Hill [underlined] battle - also at Rhode Island at 1778 - also in a private expedition lead by Lord Stirling at Staten Island in January 1780.

Schedule of the family residing with me Samuel Bailey whois by occupation a [?], which I am made to presume by means of [?] debility and wholesome constitution - My Wife - aged sixty three years, who is very infirm My Son Daniel - aged nineteen years - I have for many years subsisted on the charity of friends until my pension has relieved [?] from that burden

Samuel Bailey[signature]

[return to pre printed form] AND I Samuel Bailey[handwritten] do solemnly swear, that I was a resident citizen of the United States on the eighteenth day of March one thousand eight hundred and eighteen, and that I have not since that time, by gift, sale, or in any manner