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� [the following is a pre-printed form with handwritten inserts, deletions, additions, and testimony]

STATE OF MAINE [header]

COUNTY OF PENOBSCOT, ss.

At a Circuit Court of Common Pleas begun and holden at Bangor within and for said County on the twentyseventh of June A.D. 1820[handwritten]

ON this 27th[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] established by 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 Maine John Blake[handwritten] aged sixty seven[handwritten] years, resident in Brewer[handwritten] 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. as an Ensign in the company[inserted] commanded by Captain Nathan Goodale in the Regiment commanded by Colonel Rufus Porter in the Massachusetts Line from the first of January in the year 1777 until March 1780 when I received a Lieutenants commission and was taken [?] a corps of [?] and which last commission I resigned on the 14th of October 1780 and was therefore discharged -- All which will fully appear made by my original declaration made on the first day of April 1818, and on which declaration my certificate of Pension numbered 9.162 was granted -- I served at the battle of Long Island in 1776, and at the Battle of Trenton in 1776 - also both battles surrounding the Capture of Burgoyne and sundry other engagements

[page is divided in half, the following piece is looped to other side of page with a curve and line]

Schedule of the family residing with me - John Blake who am by occupation an husbandman which I am unable to pursue by reason of the infirmities of years - My wife Mary aged 58 years who is very feeble Grandson John B. Hayes aged 11 years Grand daughter Sally B. Hayes " " " [mark linking both grandchildren] } Orphaned and wholly dependent on me for support and both of feeble health

John Blake[signature]

[return to pre-printed form with handwritten insertions]

And I John Blake[handwritten] do solemnly swear 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 disposed of my property, or any part thereof, with intent thereby so 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, nor has any person in trust for me, any property or securities, contracts, or debts due to me; nor have I any income other than what is contained in the schedule hereto annexed, and by me subscribed; that my occupation and ability to pursue the same, together with the number and other particulars of my family, are in fact and in truth as is particularly described on the back hereof, also subscribed by me. J.M. Blake[handwritten]

[handwritten] [connected by line to other side of page] Schedule of all the estate belonging to the subscribed, necessary bedding + clothing excepted Real estate - 20 acres improved land with house + barn 145 " unimproved Do- [Ditto] Personal estate - 1 pair oxen - 9 cows - 9 sheep - 9 mares + colts - 2 swine - 1 yearling bull Framing utensils - a scanty supply for improving my farm Household furniture - a small supply for my family Debts due to me $107 - over one hundred dollars Debts owing by me $865 - eight hundred sixty five dollars

John Blake[signature]

Sworn to and declared on the twenty seventh day of June A.D. 1820 before the Court Att. Thos Cobb Clerk

[stricken] I, THOMAS COBB, Clerk of the Circuit Court of Common Pleas, for the Third Eastern Circuity, the County of Penobscot and State of Maine, do hereby certify that the foregoing [blank] and the schedule thereto annexed, are truly copied from the records of said Court, that the total amount of value of the property in the aforesaid schedule is five hundred + fiftysix[handwritten] dollars and [blank] cents. IN TESTIMONY WHEREOF, I have hereunto set my hand and set the seal of said Court on this [blank] day of [blank] A.D. 1820

[handwritten] Penobscot ss. C.C.C. Pleas June Term 1820 It is the opinion of the Court that the total amount of property exhibited and in the aforesaid schedule in five hundred + fiftysix dollars.

Att. Thos. Cobb Clerk [signature]