ANDREW C JACOBS - Co C, 27th KY INFANTRY VOLUNTEERS

Page 1

The National Archives
Cert. No. 799364
Pensioner: Telisha widow of
Veteran: Andrew C JACOBS
Can no: 61560 Bundle no: 3
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War Department
Adjutant General's Office,
Washington, Dec 6, 1887.

#619386

Respectfully returned to the Commissioner of Pensions.
Andrew JACOBS, a private of Company C, 27th Regiment Kentucky Infy. Volunteers, was enrolled on the 12th day of Oct, 1861, at Cambellsville, KY for 3 years mustered in Mch 21/62 and is reported: on muster roll from enrollment to April 30/62 present. Same to Febry 28th 1865. Mustered out with company March 29 1865 at Louisville, KY.
The records of this office furnish no evidence of disability.
Co. & Regtl. Books & Regtl. hospital records are not found.
R C DRUM Adjutant General.
By _______ (illegible)
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So. Division
Department of the Interior
Bureau of Pensions,
Washington D.C. Dec 22, 1893,

Respectfully returned to the Record and Pension Office War Department requesting an amended report giving a full military and medical history of the claimant.
No other report on file.
Cl. 421.001
Andrew C JACOBS
Co. C 27th KY Inf.
Wm Lockoen?

Address: "Chief of the Record and Pension Office, War Department, Washington, D.C."

Record and Pension Office,
War Department
Washinton, Dec 23, 1893

Respectfully returned to Commissioner of Pensions with the information that in the case of Andrew JACOB Co. C 27 Regt KY Inf military records furnish nothing additional to report dated December 6, 1887.
No medical record found.

Stamped: U S Pension Office Dec 26, 1893

Name Andrew C JACOBS has not been found on rolls Co. C 27 KY Inf.

By Authority of the Secretary of War
J C Anniooth?, Colonel, U S Army, Chief of Office
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Page 4 Declaration for Original Invalid Pension
Must be executed before a COURT OF RECORD, or some officer thereof having custody of its seal.
State of Kentucky}
County of Marion } SS On this First day of Aug, A.D. one thousand eight hundred and eighty 7 personally appeared before me a County Court Clerk, a ocurt of record within and for the County and State aforesaid, Andrew C JACOBS, aged 60 years, a resident of New Market, County of Marion, State of KY, who, being duly sworn according to law, declares that he is the identical Andrew C JACOBS who entered service under the name of Andrew C JACOBS on or about the 12th day of Oct 1861 as private in Company C of the 27th regiment of KY Inf Vols. commanded by A J BAILEY and was ____(left open)__ Discharged at Louisville, KY, on or about the 19th day of March, 1865, by reason of expiration of term of serv., that his personal description is as follows: Age, 60 years; height, 5 feet 8 inches; complexion, fair; hair, light; eyes, blue. That while a member of the organization aforesaid, in the service and in the line of duty at Corinth, in the State of Miss., on or about the ____ day of Apr, 1862 he contracted rheumatism and neuralgia from exposure. That he was treated in hospitals as follows: Camp Hospital Corinth, Miss Apr 1862. That he has not been employed in the military or naval service otherwise that as stated as above. That since the 19th day of Mch, A.D. 1865 he has not been employed in the military or naval services of the United States. That since leaving the service his occupation has been that of a farmer. hat prior to his entry into the service above named he was a man of good, sound, physical health, being when enrolled a farmer. That he is now 3/4 disabled from obtaining his subsistence by manual labor by reason of his injuries above described, recieved in the service of the United States; and he therefore makes this declaration for the purpose of being placed on the invalid pension roll of the United States.
He hereby appoints, with full power of substitution and revocation, George E Lemon, of Washington, D.C., his true and lawful attorney, to prosecute his claim. That he has never received nor applied for a pension. That his Post Office Address is New Market county of Marion, State of Kentucky. Andrew C JACOBS Claimant's signature
Two witnesses to Claimant's Signature sign here:
(1) Isaac BLAKE
(2) Tho E GREEN
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Also personally appeared John PECK, residing at New Market, KY, and J R FARMER, residing at Campbellsville, KY, persons whom I certify to be respectable and entitled to credit, and who being by me duly sworn, say they were present and saw Andrew C JACOB the claimant sign his name to the foregoing declaration; that they have every reason to believe, from the appearance of said claimant and their acquaintance with him, that he is the identical person he represents himself to be; and that they have no interest in the prosecution of this claim. (1) John PECK FARMER (Signatures of witnesses to identity of applicant)

Two witnesses to signatures of identifying witnesses sign here, when either of them signs by mark:
(1)_______ (2)_______

Sworn to and subscribed before me this 1st day of August, A.D. 1887, and I hereby ceertify that the contents of the above declaration, &c. were fully made known and explained to the applicant and witnesses, before swearing thereto, including the words _____(left open)_____, added; and that I have no interest, direct or indirect, in this claim, and am not concerned in its prosecution. A J Campbell Clerk (Signature) Taylor County Court Official Character

The Officer before whom this declaration is executed must be sure and note in his certificate all erasures and interlineations, as indicated above.
This application must be acknowledged by the claimant and identifying witnesses before a Judge, Clerk or Deputy Clerk of a Court of Record under the seal of the Court; if not so acknowledged, it will be worthless.
One Exception - Where an applicant resides more than twenty-five miles from any place at which a court is holden, upon being notified of the fact I will endeavor to have a suitable person designated, under an authority given to the Commissioner of Pensions for that purpose, before whom the declaration may be made.

(along side of page)
Stamped: Pension Office Aug 15.1887

Invalid.
Claim for Pension.
Original.
Andrew C JACOBS Applicant.
Private Co. C 27th Regiment KY Inf Vols
Enlisted 12th Oct, 1861
Discharged 19th Mch, 1865

Filed by George E Lemon
Attorney and Counselor at Law
Offices, No. 615 Fifteenth St NW
PO Drawer 325 Washington DC

As this may reach the hands of some persons unacquainted with this House we append hereto, as specimens of the testimonials in our possession, copies of letters from several gentlemen of political and military distinction and widely known throughout the United States:
House of Representatives, Washington DC, March 1, 1879.
We, the undersigned, having an acquaintance with Captain George E Lemon for the past few years, and a knowledge of the systematic manner in which he conducts his extensive business, and of his reliability for fair and honorable dealing connected therewith, cheerfully commend him to claimants generally.
A V Rice, Chairman, Committee on Invalid Pensions, House Reps.
W F Slemons, Member of Congress, Second Congressional District of Ark.
W P Lynde, Member of Congress, Fourth Congressional District of Wis.
R W Townshend, Member of Congress, Nineteenth Congressional District of Ill. Belvidere, Illinois October 24, 1875. I take great pleasure in recommending Captain George E Lemon, now of Washington, DC, to all persons who may have claims to settle or other business to prosecute before the Departments at Washington. I know him to be thoroughly qualified, well acquainted with the laws and with Department rules in all matters growing out of the late war, especially in the Paymaster's and Quartermaster's Offices. I have had occasion to employ him for friends of mine, also, in the soliciting of patents, and have found him very active, well informed, and successful. As a gallant officer during the war, and an honorable and successful practitioner, I recommend him strongly to all who may need his services.
S A Hurlbut, Member of Congress, Fourth Congressional District, Illinois, Late Major-General U S Vols.
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House of Representatives, Washington, DC
March 3, 1875
>From several years' acquaintance with Captain George E Lemon, of this city, I cheerfully commend him as a gentleman of integrity and worth, and well qualified to attend to the collection of bounty and other claims against the Government. His experience in that line gives him superior advantages.
W P Sprague, Member of Congress, Fifteenth Congressional District of Ohio
Jas D Strawbridge, Member of Congress, Thirteenth Congressional District of Penn.
====
Executive Mansion, Boise City
Idaho Territory, September 5, 1876.
Captain George E Lemon, Attorney and Agent for the collection of war claims at Washington City, is a thorough, able, and exceedingly well-informed man of business, of high character, and entirely responsible. I can assure that their interests cannot be confided to safer hands.
M Brayman, Governor of Idaho and late Maj-Gen Vols.

Any person desiring information as to my standing and responsibility will, on request, be furnished with a satisfactory reference in his vicinity of Congressional District.

I request postal stamps for replies and for return of papers.
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Certificate No. 421001
Name, Andrew C JACOBS

Department of the Interior
Bureau of Pensions,
Washington, D.C., January 15, 1898.

Sir: In forwarding to the pension agent the executed voucher for your next quarterly payment please favor me by returning this circular to him with replies to the questions enumerated below.
Very respectfully,
Clay Evans, Commissioner.

First. Are you married? If so, please state your wife's full name and her maiden name.
Answer. Tilithy EARLS marid (sic) Jany 19th 1855

Second. When, where and by whom were you married?
Answer. Rev Geo WETHERFORD at Casey Co., KY

Third. What record of marriage exists?
Answer. Ref. Clerk Office Liberty Casey Co KY

Fourth. Were you previously married? If so, please state the name of your former wife and the date and place of her death or divorce.
Answer. None

Fifth. Have you any children living? If so, please state their names and the dates of their birth.
Answer. Perry JACOBS born July 28th, 1855. Mary J JACOBS born May 20th, 1857. John S JACOBS born July 28th, 1859. Margaret JACOBS born Apr. 11, 1863. James M JACOBS born Dec 25, 1869. Andrew C JACOBS Signature.
Date of reply, May 4th, 1898
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Page 7
General Affidavit
State of Kentucky}
County of Taylor }

In the matter of the claim for Add'l Pension in the case of Andrew C JACOBS, Priv. Co C, 27th KY Vols. Personally came before me, a ____(left open)____ in and for the County and State aforesaid, John RIGGS of Finley, KY person of lawful age, who being duly sworn, declares in relation to the aforesaid claim, as follows: I first became acquainted with said Andrew C JACOBS about thirteen years ago. At that time he was nearly totally deaf in his left ear and was suffering from and complaining of chronic diarrhea and piles. His bowels were loose and irregular and he complained of pains and cramps in his bowels. He was obliged to go to stool frequently at times and was pale, weak and emaciated after such attacks. His movements in walking were impaired and he complained of paims in his rectum. He was also troubled with hemorrhages of the bowels. It was necessary to speak very loud to make him hear, especially when standing by his left side. I have lived near him during all of my acquaintance with him and have seen him on an average of three or four times a month. We have worked together a great deal and I have had good opportunity to know his condition and I know he has continued to suffer and complain as above described each year I have known him. He was under medical treatment in 1882, 82 & 84. He has been about 3/4 disabled for manual labor each year since about 1879 on account of drearly (?) total deafness* I further declare that I have no interest in said claim and I am not concerned in its prosecution. * - of left ear, diarrhea and piles and at times is unable to work at all.

If either Affiant signs by X mark, two persons who write their names must sign here as witnesses thereto.
(1) C W BROCKMAN John RIGGS
(name of one witness to X mark) (signature of affiant)
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Page 8

(from the other side)
Sworn to and Subscribed before me, this 27th day of April 1892 at Finley, in the County of Taylor, State of Kentucky and I hereby certify that the contents of the foregoing affidavit were fully made known and explained to the affiant __ before swearing thereto, including the words ____(left open)____ erased and the words ____(left open)____ added; that the affiant ____ to me well known and ____ apparently respectable and worthy of full credit, and I fully certify that I have no interest, direct or indirect, in the prosecution of this claim. John SCHOOLING Signature of the Officer before whom executed J P M C Official Title of the Officer

The Officer before whom this affidavit is executed must note in his certificate all erasures and interlineations as indicated above.
Note: This paper may be executed before any officer authorized to administer oaths for general purposes. Certificate of Clerk of Court need not be attached; but will be procured when called for by the Department. In numerous instances the official characters of the Notary or Magistrate is already officially known at the Department.

(along side of page)
Case of
Andrew C JACOBS
Priv Co. C 27th KY Inf Vols.
for Add'l Pension
Affidavit of _________
Filed by Milo B Stevens & Co
Attorneys and Solicitors

Stamped: U S Pension Office May 14 1892
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Page 9

Continuance Affidavit

Important - Great care should be exercised in filling this affidavit in accordance with the instructions contained in the margin. Read the instructions very carefully before undertaking to write or prepare the affidavit.

Instructions.
The affiant should state the facts following:

1. State in about what month and year you first saw the soldier or sailor, or made his acquaintance, after his discharge. What disabilities her was then afflicted with. Describe, as fully and clearly as possible the symptoms of said disabilities as they appeared to you at the time.
2. State the length of time you have known of the soldier's or sailor's physical condition, and whether during said period he continued from time to time, to complain of, and appeared to be suffering from the aforementioned disabilities.
3. State about how often in each year or month during the period covered by your testimony you have seen the soldier or sailor; whether you lived in his immediate neighborhood during said period; whether you worked together, or for each other, at intervals, during said period he was at any time obliged to stop work, or was confined to his bed or house, because of the disability or disabilities mentioned.
4. State about what proportion of a sound, able-bodied man's work the soldier or sailor was able to do, whether 1/3, 1/2, 3/4 or as the case may have been, during the period covered by your testimony.

Read carefully. You should then further state, if true: That your testimony was written by you; that in writing the same you did not use, and was not aided or prompted by any written or printed statement or recital, prepared or dictated by any other perosn, and not attached as an exhibit to your testimony. If the affidavit is not written by you, then the following statement should, if true, be added: That the statements contained in the affidavit were written in your presence, and from your oral statements to the person preparing the affidavit (giving name of the person); also stating the date and place (town or city) where such oral statements were made to the person preparing the affidavit, and that in making the same you did not use, and was not aided or prompted by any written or printed statements or recital, prepared or dictated any other person, and not attached as an exhibit to your testimony.

State of Kentucky}
County of Green }SS In the matter of the claim for Andrew C JACOBS, late private Co C 27th Regiment KY Vol. Personally came before me, a Clerk of the County Court in and for the County and State aforesaid B L BELL, Post Office Greensburg, Green Co., KY person of lawful age, who, being duly sworn, declare in relation to the aforesaid claim, as follows: I first saw the above named soldier about April 1865 and he was complaining of deafness of left ear, diarrhea & piles. I lived about one quarter of a mile of him from 1865 to 1869 and saw him often and he complained all the time he was growing worse especially his hearing. He often had to quit work on account of diarrhea & piles and was not able to do more than one fourth of a days work during that time.
I further declare that I no interest in said claim, and am not concerned in its prosecution. B L BELL Signature of Affiant

Stamped: U S Pension Office Oct 27, 1897
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Page 10

Sworn to and Subscribed before me, this 25th day of Nov 1893 at Greensburg in the County of Green State of Kentucky and I hereby certify that the contents of the foregoing affidavit were full made known and explained to the affiant before swearing thereto, including the words ____(left open)_____ erased, ____(left open)____ and the words added; that the affiant is to me well known, and is apparently respectable and worthy of full credit, and I fully certify that I have no interest, direct or indirect, in the prosecution of this claim. H T LARIMORE, Clk Name of Officer before whom executed Green County Court State whether Justice, Notary, Clerk or Deputy Clerk

The Officer before whom this affidavit is executed must note in his certificate all erasures and interlineations, as indicated above.
Note - This paper may be executed before any officer authorized to administer oaths for general purposes. Certificate of Clerk of Court need not be attached, but will be procured when called for by the Department. In numerous instances the official character of the Notary or Magistrate is already officially known at the Department.

(along side of page)
Increase New? Disab.
Ad. Oct 24/94
No. 421.001
Case of Andrew C JACOBS
Late Priv. Co. C 27th Reg't KY Infty Vols.
For Pension Affidavit of B L BELL
Filed by Milo B Stevens & Co
Solicitors of Claims.
Washington, DC
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Page 11

(all handwritten page)
Stamped: U S Pension Office Mar 12, 1894

State of Kentucky}
County of Green } In the matter of the claim of Andrew C JACOBS late private Co C 27th Regiment KY Vols. Personally came before me a deputy clerk of the Green County in the State of Kentucky, Mrs M E BELL of Greensburg, Green Co., KY a person of lawful age who being duly sworn declares in relation to the aforesaid claim as follows. I first saw the above named soldier about April - 1865 and he was complaining of deafness of left ear, diarhear (sic) & piles. I lived about one quarter of a mile from him from 1865 to 1869 and saw him often two to three times a month and he was complaining all the time I saw him. I often heard of him having to quit work on account of his health.  don't suppose he was able to more than one fourth of an able bodied man's work during the time knew him. All this affidavit was written in my presence by A G HAMILTON at my residence in Green County, KY Feby 8th, 1894. From the oral statements made to him by me which were reduced? to be written by him in my
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Page 12

presence, that I did not use and was not aided or prompted by any written or printed statement or recital prepared or dictated by any other persons. I attach no exhibit to this affidavit because I have non to attach and I further declare that I have no interest in this claim and am not concerned in its prosecution. M E BELL
Stamped: U S Pension Office Mar 12 1894

Sworn to and subscribed before me this 8th day of February 1894 at Greensburg in the County of Green State of Kentucky and I hereby certify that the contents of the foregoing affidavit were fully made known and explained to the affiant before swearing thereto including the words erased and the words added. The affiant is to be well known and is apparently respectable and worthy of full credit and I fully certify that I have no interest, direct or indirect, in the prosecution of this claim. H T LARIMORE, Clerk By U G HAMILTON, D C
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Page 13

Group 2
3-1081
Pensioner Dropped
Department of the Interior
Bureau of Pensions

Mar 7, 1916
Certificate No. 799364
Class Act April 19, 1908
Pensioner Telisha JACOBS
Soldier Andrew C JACOBS

The Commissioner of Pensions.
Sir:
I have the honor to report that the name of the above described pensioner who was last paid at $12, to Feb 4, 1916 has this day been dropped from the roll because of death Feb 9 - 1916.
Telisha JACOBS Spurlington, KY
799364 Act Apr
Very respectfully, W Manphell???, Chief, Finance Division
-Note - Every name droopped to be thus reported at once, and when cause of dropping is death, state date of death when known.
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Page 14

Act of April 19, 1908
No 799, 364
Original
United States of America
Department of the Interior
Bureau of Pensions

It is hereby certified that in conformity with the laws of the United States Telisha JACOBS widow of Andrew C JACOBS who was a Private, Co. C. 27th Regiment, Kentucky Infantry is entitled to a pension at the rate of twelve dollars per month, to commence March 22, 1915 and to continue during her widowhood.
Given at the Department of the Interior this tenth day of November one thousand nine hundred and fifteen and of the Independence of the United States of America the one hundred and fortieth. Mullin? _ane? Secretary of the Interior
Countersigned G M Saltzgaber Commissioner of Pensions
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Page 15

That section forty-seven hundred and forty-five, title fifty seven of the Revised Statutes of the United States is hereby amended to read as follows: Sec: 4745 - Any pledge, mortgage, sale, assignment or transfer of any right, claim or interest in any pension which has been or hereafter be, granted, shall be void and of no effect, and of any person who shall pledge or receive as a pledge, mortgage, sale, assignment or transfer of any right of claim or interest in any pension or pension certificate which has been or may hereafter be granted or issued or who shall hold the same as collateral security for any debt or promise or upon any pretext of such security or promise shall be guilty of a misdemeanor, and upon conviction thereof shall be fined in a sum not exceeding one hundred dollars and the costs of the prosecution, and any person who shall retain the certificate of a pensioner and refuse to surrender the same upon the demand of the Commissioner of Pensions or a United States pension agent or any other person authorized by the Commissioner of Pensions or the pensioner to receive the same shall be guilty of a misdemeanor and upon conviction thereof shall be fined in a sum not exceeding one hundred dollars and the costs of the prosecution. Approved - February 28, 1883.

(along side of page)
No. 799,364
Pension Certificate of
Telisha JACOBS
Payable quarterly by the Disbursing Clerk,
Bureau of Pensions
Group 2
WEB, Clerk
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Page 16

General Affidavit

State of Kentucky}
County of Marion }

In the matter of the claim for add'l pension in the case of Andrew C JACOBS Priv. Co. C 27th KY Inf. Vols. Personally came before me, a ____(left open)____ in and for the County and State aforesaid, George F RIGGS of New Market, KY person .....of lawful age, who being duly sworn, declares in relation to the aforesaid calim, as follows:
I have been well and intimately acquainted with said Andrew C JACOBS for the last thirteen years and during all of said period he has been nearly totally deaf in his left ear and suffering from and complaining of chronic diarrhora (sic) and piles. His bowels have been loose and irregular and he has complained of pains and cramps in his bowels. He has bee weak and emaciated after attacks of diarrhora (sic) and has been troubled with hemorrhages of the bowels. His movements in walking have been impaired and he has also complained of pains in rectum. I know he has been nearly totally deaf in his left ear each year of my acquaintance with him all the time and have seen him three or four times a month. We have worked together a good deal. He was under medical treatment in 1882, 83 and 84 for his said troubles. He has been about three fourths disabled for manual labor each year of my acquaintance with him on account of piles, diarhoea (sic) and nearly total deafness of left ear. At present he is not able to work at all. I further declare that I have no interest in said claim and I am not concerned in its prosecution.

If either Affiant signs by X mark, two persons who write their names must sign here as witnesses thereto.
(1) R F RAKESTRAIN? George x S RIGGS
(Name of one witness to X mark) Signature of Affiant
(2) Wm McWHARTON
(Name of other witness to X mark)
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Page 17

Sworn to and Subscribed before me, this 27th day of April 1892 at New Market, KY, in the County of Marion State of Kentucky and I hereby certify that the contents of the foregoing affidavit were fully made known and explained to the affiant before swearing thereto, including the words ____(left open)____ erased and the words ____(left open)____ added; that the affiant ____ to me well known and ____ apparently rerspectable and worthy of full credit, and I fully certify that I have no interest, direct or indirect, in the prosecution of this claim. John SCHOOLING Signature of Officer before whom executed JPMC Official title of the Officer
The Officer before whom this affidavit is executed must note in his certificate all erasures and interlineations as indicated above.
Note - This paper may be executed before any officer authorized to administer oaths for general purposes. Certificate of Clerk of Court need not be attached; but will be procured when called for by the Department. In numerous instances the official characters of the Notary or Magistrate is already known at the Department.

(along side of page)
Ctf. No. 421,001
Case of Andrew C JACOBS
Priv Co C 27th KY, Inf Vols
for Add'l Pension
Affidavit of ___________
Filed by Milo B Stevens & co.
Attorneys and Solicitors
Cleveland Office
Stamped: U S Pension Office May 14 1892
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Page 18

Act of April 19, 1908
Declaration for Widow's Pension

State of Kentucky}
County of Taylor }

On this 19th day of March A.D. one thousand nine hundred and fifteen personally appeared before me, a County Clerk within and for the county and State aforesaid, Telitha JACOBS, aged 78 years, a resident of Spurlington, county of Taylor, State of Kentucky, who, being duly sworn according to law, makes the following declaration in order to obtain pension under the provisions of the ACT OF CONGRESS APPROVED APRIL 19, 1908. That she is the widow of Andrew C JACOBS, who was enrolled under the name of Andrew C JACOBS, at Greensburg, KY, on the 12 day of October, 1861 as a private in Company C 27th KY Inf Volunteers, and honorably discharged March 19, 1865 having served ninety days or more during the late civil war. That he was not in the military or naval service of the United States otherwise that as stated above. That she was married under the name of Telisha EARLS to said soldier at in Marion County, KY on September 1854 by George Weatherford that there was no legal barrier to marriage; that she had never been previously married; that the soldier had never been previously married. That the said soldier died January 29th, 1916 at Spurlington, KY; that she was not divorced from him, and that she has not re-married since his death. That the soldier left the following-named children who are now living and under the age of sixteen years of age, to wit: (If the soldier left no children, the claimant should so state) - none under 16 years of age. That she has not heretofore applied for pension. That her post office address is (street and number), city or twon of Spurlington, county of Taylor, State of KY.
Attest: (1) N M HAYWOOD Telisha x JACOBS (2) H ABLE Claimant's signature on full.

Also personally appeared W M GOODIN, residing Marion Co., KY and S P NEWTON, residing in Marion Co., KY, persons whom I certifyto be respectable and entitled to credit, and who, being by me duly sworn, say they were present and saw Telitha JACOBS, the claimant sign her name (or make her mark) to the foregoing declaration, that they have every reason to believe, from the appearance of said claimant and their acquaintance with her of 25 years and 20 years, respectively, that she is the identical person she represents herself to be, and that they have no interest in the prosecutin of this claim.
Declaration accepted as W M GOODIN
a claim under the act of S P NEWTON
April 19, 1908. Signature of witnesses. Chief Law Division

Subscribed and sworn to before me this 19th day of March, A.D. 1915; and I hereby certify that the contents of the above declaration, etc., were fully made known and explained to the applicant and witnesses before swearing, including the words ____(left open)____, erased and the words ____(left open)____ added; and that I have no interest, direct or indirect, in the prosecution of this claim. C W RAMSEY - Signature County Clerk - Official Character By A A PURYEAR, D C
Stamped: U S Pension Office Mar 22 1915
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Page 19

Finance Div. notified of death Mar 23, 1915
No. 421,001
An act of April 19, 1908
Claim for Pension
Widow

Soldier - Andrew C JACOBS
Service - Co C 27th KY Inf
Cf. 421,001

Instructions - This form may be used for original pension under Act of April 19, 1908. Declaration and testimony in support of same to be executed before some officer of a court of record having custody of its seal, a notary public, justice of the peace, or other officer authorized to administer oaths for general purposes. If such officer is not required by law to have and use a seal, his official character, signature, and term of office must be certified by the proper State, county or city officer under his official seal, unless such certificate has been filed in the Bureau of Pensions for general reference.
Stamped: Law Division Mar 22 1915

An ACT

To increase the pension of widows, minor children, and so forth, of deceased soldiers and sailors of the late civil war, the war with Mexico, the various Indian wars, and so forth, and to grant a pension to certain widows of the deceased soldiers and sailors of the late civil war. ______________ Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, That from and after the passage of this Act the rate of pension for widows, minor children under the age of sixteen years, and helpless minors as defined by existing laws, now on the roll or hereafter to be placed on the pension roll and entitled to receive a less rate than hereinafter provided, shall be twelve dollars per month; and nothing herein shall be construed to affect the existing allowance of two dollars per month for each child under the age of sixteen years and for each helpless child; and all Acts or parts of Acts, inconsistent with the provisions of this Act are hereby repealed: Provided, however, That this Act shall not be so construed as to reduce any pension under any Act, public or private. Sec.2 That if any officer or enlisted man who served ninety days or more in the Army or Navy of the United States during the late civil war, and who has been honorably discharged therefrom, has died, or shall hereafter die, leaving a widow, such widow shall, upon due proof of her husband's death, without proving his death to be the result of his army or navy service, be placed on the pension roll from the date of the filing off her application therefor under this Act at the rate of twelve dollars per month during her widowhood, provided that said widow shall have married said soldier or sailor prior to June twenty-seventh, eighteen hundred and ninety; and the benefits of this seciton shall include those widows whose husbands, if living, would have a pensionable status under the Joint Resolutions of February twenty-eighth, nineteen hundred and six. Sec. 3 That no claim agent or attorney shall be recognized in the adjudication of claims under the first section of this Act, and that no agent, attorney, or other person engaged in preparing, presenting, or prosecuting any claim under the provisions of the second section of this Act shall, directly or indirectly, contract for, demand, receive, or retain for such services in preparing, presenting, of prosecuting such claim a sum greater than ten dollars, which sum shall be payable ony upon the order of the Commissioner of the Pensions by the pension agent making payment of the pension allowed; and any person who shall violate any of the provisions of this section, or who shall wrongfully withhold from the pensioner or claimant the whole or any part of a pension or claim allowed or due such pensioner or claimant under this Act shall be deemed guilty of a misdemeanor, and upon conviction thereof shall, for each and every such offense, be fined not exceeding five hundred dollars or be imprisoned at hard labor not exceeding two years, or both, in the discretion of the court.
Approved April 19, 1908.