Act of February 6, 1907


DECLARATION FOR PENSION


THE PENSION CERTIFICATE SHOULD NOT BE FORWARDED WITH THE APPLICATION



State of California
County of Los Angeles, ss.


On this 30th day of February, A. D. one thousand nine hundred and twelve personally appeared before
me, a notary public within and for the county and State aforesaid, Jeremiah Bennett, who, being
duly sworn according to law, declares that he is 75 years of age, and a resident of Los Angeles
county of Los Angeles, State of California; and that he is the identical person who ENROLLED at
Shelbyville, Indiana under the name of Jeremiah Bennett, on the 23 day of April, 1861, as a
Private, in Co. C, 7th Indiana Vol Inft and honorably discharged at Indianapolis, Indiana, on Aug
2nd 1861 and then enrolled at Indianapolis Ind on Dec 2nd 1861 in Co A, 16th Indiana Vol Inft, &
honorably discharged at Washington D.C. on May 14th 1864 and enrolled at Shelbyville, Indiana on
July (?) 7th, 1864 in Co D, 134th Reg Ind Vol Inft & honorably discharged at Indianapolis, Ind.
on Sept 2 1864 in the service of the United States, in the Civil War, and was HONORABLY DISCHARGED
. . .

That he was not employed in the military or naval service of the United States otherwise than as
stated above.  That his personal description at enlistment was as follows:  Height, 5 feet 6
inches; complexion, light; color of eyes, blue; color of hair, dark; that his occupation was clerk;
that he was born Shelbyville Indiana, 1837, at February 2nd.

That his several places of residence since leaving the service have been as follows:  Shelbyville
Ind Sep 1864 to Nov 1864, Indianapolis Ind Nov 1865 (should read 1864) Sep 1865, North Manchester
Ind Sept 1865 to Nov 1865, Shelbyville Ind Nov 1865 to Feb 1905, Los Angeles Cal, Feb 1905 to date.

That he is a pensioner.  That he has heretofore applied for pension Certificate 295420.

That he makes this declaration for the purpose of being placed on the pension roll of the United
States under the provisions of the act of February 6, 1907.

That his post-office address is 3004 Hobart Blvd, county of Los Angeles, State of California.


(Claimant's signature in full.)  Jeremiah Bennett
                                 3004 Hobart Blvd.
                                 Los Angeles, Cal.


Attest:                      1.  Dr. Willis E. Hutchason

                             2.  John W. Funk


Also personally appeared Dr. Willis E. Hutchason, residing in Los Angeles, Cal and John W. Funk,
residing in Los Angeles, Cal, persons whom I certify to be respectable and entitled to credit,
and who, being by me duly sworn, say that they were present saw the claimant sign his name
(or make his mark) to the foregoing declaration; that they have every reason to believe, from the
appearance of the claimant and their acquaintance with him of 19 years and 2 years, respectively,
that he is the identical person he represents himself to be, and that they have no interest in the

prosecution of this claim.



(signature of witnesses.)     Dr. Willis E. Hutchason
                              John W. Funk


Subscribed and sworn to me this 3rd day of February, A. D. 1912, 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 May 7th, erased, and the words . . . , added,
and that I have no interest, direct or indirect, in the prosecution of this claim.


(signature.)                  G. G. Johnson
(Official character.)         Notary Public