STATE OF TENNESSEE
_________________County }  _____________________ of said State and County, desiring to avail herself of the Pension allowed to Indigent Widows of Tennessee Soldiers, under Act of General Assembly, approved April, 1905, begin Chapter 202 of the Acts of 1905, hereby submits her proofs, and after begin duly sworn true answers to make to the following questions, deposes and answers as follows:

1. What is your full name and where do you reside? (Give State, County and Postoffice).
2. How long and since when have you been a resident of this State?
3. When and where were you born and what was your maiden name?
4. When and where was your husband born -- state his full name, and when and where were you and he married, and who performed the marriage ceremony? (Attach certified copy marriage license in every case.)
5. When and where and in what Company and Regiment did you husband enlist or serve during the war between the States?
6. How long did your husband serve in said Company and Regiment?
7. When and where did your husband's Company and Regiment surrender?
8. Was you husband present at the time and place when his Company and Regiment surrendered?
9. If not with his command at surrender state clearly and specifically where he was when he left command, for what cause and by what authority?
10. When and where did your husband die?
11. At the time of your husband's death, were you living with him as his lawful wife?
12. How many children did you have by your said husband? Give sex and age at this time.
13. What property, real or personal, or income do you have or possess, and its gross value?
14. What property, real or personal, did you possess at death of husband or did he leave you, and what disposition, if any, by sale or gift, have you made of the same?
15. Have you a family? If so, who composes such family? Give their means of support? Have they any lands or other property?

Sworn to and subscribed before me, this the                      ______________________________
_____ day of ______ 190__
_______________________
 

of _______________ County

STATE OF TENNESSEE,
_________________ County }

___________________________ of the said State and County, having been presented as a witness in support of the application of Mrs. ______________________ for a Pension under Chapter 202, Acts of 1905, and after being duly sworn true answers to make to the following questions, deposes and answers as follows:
 

1. What is your name and where do you reside?
2. Are you acquainted with the applicant, Mrs. ________________ If so, how long have you known her? ___________
3. Where does she reside, and how long and since when has she been a resident of this State?
4. When and where was she born?
5. Were you ever acquainted with her husband?
6. When and by whom were they married?
7. When and where was he born?
8. How long did you know him?
9. When and where did _______________________ enlist in the war between the States, and in what Company and Regiment did he enlist, and how do you know this?
10. Were you a member of the same Company and Regiment?
11. How long did he perform regular military duty?
12. When and where was his Company and Regiment surrendered?
13. Were you with the command when it surrendered?
14. Was __________ the husband of applicant present?
15. If not present, where was he?
16. When and where did he leave his command? _________________________ For what cause? ____________________ By whose authority did he leave? __________________ How do you know all this? (State fully and clearly) __________
17. When and where did _____________ die?
18. Where did he reside at his death and how long had he been a resident of Tennessee at his death?
19. Do you of your own knowledge know that applicant is the lawful widow of ______________________?
20. Has she remained unmarried since her soldier husband's death, and is she now his widow?
21. What property, effects or income has the applicant, if any, and how do you know this of your own knowledge?
22. Has applicant conveyed any property in last two years or given any away, if so, what was it and to whom?

Sworn to and subscribed before me this ____
day of _____ 190___

___(witness signature)____
___(notary public)________

I, _________________ Trustee of __________________ County, Tennessee, hereby certify that the property assessed on the tax books of this County to Mrs. ____________________ the widow of ___________________ amounts to $____ restate and $_____ personal.
  ___________________ Trustee For  _____________________ County, Tenn.

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Certificate of Clerk of Court or Notary Public

I, _____________ Clerk or Notary Public, in and for said County, hereby certify that the applicant, Mrs. ___________ resides in said County, and has been a bona fide resident of this State since the _______ day of ________ 18__, and that the witnesses,
Mr. ____________________ are of trustworthy character, and that their statements are entitled to full faith and credit.

I do further certify that before answering the foregoing questions, the applicant and said witnesses took the oath herein prescribed, and the full text of the affidavits was read to the applicant and witnesses before the same was signed and subscribed.

Witness my hand and official seal this ____ day of _____ 190___

[SEAL]                            __________________________ (notary public)
                                       __________________________ County

NOTES --

1. Before any questions are answered, the Clerk or Notary shall swear applicant and the witnesses in the following words: "You do solemnly swear that you will true answers make to each of the questions asked of you, and the evidence you shall give will be the whole truth; So help you God."
2. Additional affidavits may be attached, if blank spaces are insufficient.
3. All affidavits must be made before an officer using a seal.
4. Only widows who were the wives of Tennessee soldiers need apply -- and now are widows. Those married since December 31, 1869, not entitled.
5. Two witnesses are necessary to make out claim.
6. Attach certified copy marriage license in every case, or certificate of Clerk of County Court, under seal, that license is filed in his office, duly certified by officiating minister, or the affidavit of the officiating minister, or the affidavit of two witnesses of the ceremony.