|
Rate, $8.00 per month, commencing May
24th 1869, and $12.00 from
March 19, 1886 and two dollars a month additional for each child, as follows:
| By last marriage: |
William A. {sixteen
, 18 .} |
Commencing , 18 . |
| |
Susana born { June
2, 1854
Susasa, {sixteen- June 1, 1870.} |
Commencing May 24
, 1869 |
| |
Matilda born {Sept.
15, 1857
Matilda, {sixteen-Sept. 14, 1873.} |
Commencing May 24
, 1869 |
Payments on all former certificates covering any portion of same time
to be deducted.
All pensions to terminate
_______________, 18 , date of ____________
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
RECOGNIZED ATTORNEY:
Name George
E. Lemon  Fee $ 10.00 , Agent ~~~ to pay.
P. O. City____________. Articles filed none________, 18
- .
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
APPROVALS:
Submitted for Special Examination Report, Admission Feb. 15th,1888
Wray Bettie, Examiner.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Approved for Admission ______, origin of Disease of Lungs
, ________accepted,
George W. Taylor , March 8 , 1888, Legal Reviewer. Brandebury
, Re-Reviewer.
Approved for Admission _______; death resulted from disease
of lungs due to same which has been legally accepted,
W. H. Coe
March
16th, 1888,
Medical Reviewer.
Medical
Expert – John Campbell, Medical Refree.
|
