ON THIS 23rd day of June A.D. one thousand nine hundred 1900 personally appeared before me, a Deputy Clerk Probate Court Canton, Ohio within and for the County and State aforesaid, Charles F. Stokey aged fifty-five years a resident of Canton County of Stark State of Ohio, who, being duly sworn according to law, declares that he is a pensioner of the United States, enrolled at the Columbus O Pension Agency at the rate of Eight dollars per month, Certificate No. 981343 ; by reason of disability from ulceration of bowels, stomach trouble and liver complaint based upon his service in the military service of the United States as a Private in Company H 195 OVI
That he believes himself to be entitled to a re-rating, as the rate originally allowed him was too low and not commensurate with the extent of his disability, nor in proportion to the rate allowed to other similar and equivalent disabilities.
That his physical disability is substantially total resulting from bowel trouble and has greatly increased since his examination and is now and for some time has been such as to wholly prostrate him and prevent his doing anything + He believes himself justly entitled to the highest rate allowed und the act of June 30. 1890 and he hereby applies for reexamination and a rerating and an allowance of pension commensurate to his actual disability.
that he hereby appoints, with full power of substitution and revocation, James J Clark of Canton Ohio his true and lawful attorney, to prosecute his claim.
His Post Office address is 907 West 9th Street Canton Ohio
Charles F Stokey Signature of Claimant
H W Zaiser W L Ernbaugh Two Witnesses who witness him
Also personally appeared H. W. Zaiser residing at Canton Ohio and Wm. L. Ernbaugh residing at Canton, Ohio persons whom I certify to be respectable and entitled to credit, and who being by me duly sworn, say that they were present and saw Charles F. Stokey , 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.
H W Zaiser W L Ernbaugh (Signatures of Affirmants.)
Sworn to and subscribed before me this 23rd day of JuneAD 1900 and I hereby certify that the contents of the foregoing declaration were fully made known and explained to the applicant and witnesses before swearing, and that I have no interest, direct or indirect, in this claim, and am not concerned in its prosecution.
[The cover part.] INVALID Claim for Re-Rating. Charles F Stokey Applicant
Co. H. 195 Reg't O. V. Inf
Pension Certificate No. 981,343
FILED BY James J Clark atty Canton O
Printed and for sale by J. F. Shedry, Claim Desk Printer, 413 D Street, N. W., Washington, D.C.
[An additional page]
Under Act of June 27, 1890. (3-217a.) INCREASE Claim to No. 981,343 Charles F. Stokey P.O., #907 West 9th Street Canton State, Ohio Application filed June 26, 1900 State/Service, H. 195 Ohio Inf. Oct 3-1900-lett to M.F.S.
It's fun to think about this pre-printed form, from before the days when computers made everything easier. So many people were applying for pension increases that there was a form for it. Thanks, Johannes Gutenberg!