|
APPLICATION FOR PENSION.
State
of
I, C.
K. Smith do
solemnly swear that I
served
as a soldier in the army (or sailor in the navy) of the Confederate
States, being a mem-
ber
of the 12th
from
the State of or
a member of the crew of the ship
called
_____; that I was honorably
discharged (paroled or released)
from
such service on or about the 15th
day of June
1865
and
did not desert the same; that I am now, and for the past twelve months have
been, a bona
fide
resident of this State; that I do not myself, nor does my wife, nor do we both
together,
own
property, real or personal, or both, or money or choses in action in excess of
the value of
$400.00
(exclusive of household goods and wearing apparel), nor has either of us
conveyed
title
to any property to enable me to draw a pension, and that neither I nor my wife
is in
receipt
of any income, annuity, pension or wages for services, emoluments of an office,
in
excess of $150.00 per year; that I am incapacitated to perform manual labor in
any of the
ordinary
avocations of life (or am totally blind), and that such incapacity (or
disability) is the
result
of wounds received in the service, being hurt
at Post Hutson
wile [sic] building breast works .
(Here Describe same generally.)
State
of
We, the undersigned, sitting as a
Pension Board for _[blank]
do
certify that we have examined the application of the within name
C. K. Smith for
pension, under Act of the General Assembly of
the
State of
that
said applicant C. K. Smith
a wounded Confederate
soldier,
is
in indigent circumstances, and wholly or partially incapacitated for manual
labor, and that
his
claim is _[blank]_ just, and that he should _[blank]_ be allowed
$
50.00
pension.
W. P. Stewart [Seal]
F. T. Wright [Seal]
R. H. Prince [Seal]
APPLICATION OF
C. K. Smith
DeAnn P.O.
Examined and Approved
and $
50.00 allowed
and Auditor
authorized to draw warrant for same.
Filed June 7th 1901
C. H. Goodbelt Chs?
By E. B. Black, DC
This 20th
day of Aug
1901
J. V. Crockett Sec’y
of State.
T. C. Monroe Auditor.
PROOF OF SERVICE
(By Comrades If Possible)
State
of
Justice of the Peace within
and for the County
of
and
State of
citizens
of Hempstead County Ark
, whom I certify to be credible
persons
and worthy of confidence, who being duly sworn, state that they are each,
personally, well ac-
quainted
with the applicant C. K.
Smith and
have known him
about 35 years.
That the material facts set forth in
his application for pension are true. That he was a Con-
federate
solider. Belonged to Company K
Regiment of 12
That
he was wounded in said service at Post
in the following manner, was ruptured in bowels
building
That
this information we derive from the following sources 1.
W. J. Clark from
statement of him + other Comrades;
2. J. H. Clark was a Comerad [sic] was with
the said applicant at the time specified
That
he is wholly or partially incapacitated for manual labor, and that we have no
interest in this claim.
W. J. Clark
J. H. Clark
Subscribed and sworn to before me this 17
day of July
1893
P. J. Ahnand? JP
EVIDENCE OF PHYSICIAN.
State
of Arkansas, }
County
of __[blank]__ } SS.
I, H.
W. Whipple , a duly registered
and
practicing Physician in Hempstead
County, Arkansas, do certify
that
I am personally acquainted with C.
K. Smith , an
applicant
for pension under the Statutes of Arkansas, and that he is incapacitated for
manual labor by
reason
of a Double
Inguinal Hernia , and
by
reason of said wound disability
he is in indigent
circumstances.
H. W. Whipple M.D.
Subscribed and sworn to before me this 18th
day of
July 1893. J. F. Johnson Co Clk
PROOF OF SERVICE
(By Comrades if Possible)
State
of
On this day personally came before me
the undersigned, a
Justice of the Peace within
and for the
and
State of
citizens
of De Ann
whom I certify to be
creditable persons
and
worthy of confidence, who being duly sworn, state that they are each,
personally, well
acquainted
with applicant C. K. Smith
and have
known
him 40
years, respectively.
That he was a Confederate soldier.
Belonging to Company K
Regiment
of
12th
to
June 1865
That he was honorably
discharged (paroled or released) from
such
service, and did not desert the same. That he is now and has been for the past
twelve
months
a bona fide resident of
of
Rupture
and that such incapacity
(or
disability)
is not the result of his own vicious habits still persisted in. That to the best
of our
knowledge,
all property now owned by him and his wife, together, is not worth exceeding
$400
(exclusive
of household goods and wearing apparel). That neither he nor his wife is in
receipt
of
any income, annuity, pension or wages for any services, or the emoluments of an
office,
in
excess of $150 per year. That we have no interest in this claim.
J. W. Clay
J. M. Prince
Subscribed
and sworn to before me this 4th
day of June
1901.
J. F. Willis J.P.
EVIDENCE OF PHYSICIAN.
State
of
I, H.
W. Whipple a
duly registered and practicing physician
in
Hempstead
County,
well
acquainted with C. K. Smith
of
De Ann
That at his request I have made an
examination of his physical condition and find:
State
description and character of wound result
of accident
while at work on defines of Port
resulting in Double femoral hernia
Physical
condition and to what cause is his incapacity for manual labor attributable
Femoral hernia of both side
also scrotal hernia .
and
that said disability is not the result of his own vicious habits still persisted
in
Extent
of disability nearly total
H. W. Whipple
[page
cut off]
[scans
courtesy of Johnnie Smith Griffin, email, 08 May 2008]
