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� [the following is a pre-printed form with handwritten insertions, deletions and exhibits] STATE OF MAINE

KENNEBEC COUNTY, ss.

On the Eighteenth [handwritten] day of September [handwritten] --- , 1820 personally appeared before Nathan Weston Junior [handwritten] a [handwritten] Justice of the Circuit[stricken] Supreme Judicial [handwritten inserted] Court of Common Pleas for the Counties of Lincoln, Kennebec and Somserset, [stricken] being a Court of Record for said Counties [stricken] State [handwritten inserted] proceeding according to the course of the common law, having original jurisdiction, unlimited in amount, being a record of their proceedings, and having the power of fine and imprisonment, John Burrell [handwritten] aged sixty eight [handwritten] years, resident in Plan No. 3[handwritten] [Plantation No 3] in the County of Penobscot [handwritten] within said Circuit [stricken] State [handwritten insertion] 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 Fuller [handwritten] and Regiment commanded by Colonel Bond [handwritten] of the line of the State of Massachusetts [handwritten] upon the Continental Estblishment, for the period of one year [handwritten]