Scott County Arkansas Civil War Pension Applications George W. McClain Contributed by Carrie Moos Email: moos@worldnet.att.net USGENWEB NOTICE: In keeping with our policy of providing free Information on the Internet, data may be used by non-commercial entities, as long as this message remains on all copied material. These electronic pages may NOT be reproduced in any format for profit or for presentation by other persons or organizations. Files may be printed or copied for personal use only. Persons or organizations desiring to use this material for purposes other than stated above must obtain the written consent of the file contributor. ================================================================= Note: George W. McClain was closely related to John McClain, whose Pension file I have also contributed. George was probably a brother or a nephew to John and they served together in the same Regiment, were listed together on the Scott County census in 1850 in the household of Anna McClain & were living next door to one another in 1870. George married Martha S.A. McClain, who was the daughter of John Lenore and Hannah (Clubb) McClain of Yell County, Arkansas. If you have information about either of these McClain families, please contact me at moos@worldnet.att.net. Carrie Moos Certificate #736367 SOLDIER'S PENSION CLAIM [Undated, but stamped at Pension Office 19 March 1891] State of Arkansas, County of Hot Spring, SS: Mr. George W. McClain, being duly sworn, says: My Post Office Address is Magnet, Arkansas My occupation is that of Farmer. I was born in Scott Co., Arkansas on the 3 day of August 1845. My personal description is as follows: Height 5 feet 4 inches; complexion light; color of hair light and of eyes Blue. I am married; my wife's name is Martha A. McClain. My places of residence since the war have been: from about 1865 to about 1866, in Yell County, State of Arkansas, my P.O. address being Rover; from about 1866 to about 1882, in Scott County, State of Arkansas my P.O. address being Park; from about 1882 to about 1888 in Garland County, State of Arkansas, my P.O. address being Arkinville[?] from 1888 to 1891 Hot Spring Co., Ark. The following is a full and complete statement of all the service ever rendered by me in the military or naval service of the United States: I enlisted at Little Rock, Arkansas on the 23 day of December 1863, to serve three years, in Company E of the 3rd Regiment of Ark. Cav. Vols., and was honorably discharged therefrom at Lewisburg, Ark. on the 30 day of June 1865. I now have the following injuries, diseases or disabilities, each of which was caused or incurred as stated opposite thereto and neither of which is the result of vicious habits on my part: Rheumatism, caused by exposure during the war at Lewisburg, about January 1864. Rupture, caused by strain at Garland Co. about 1884. Each of said disabilities is permanent in character, and they incapacitate me for manual labor in such a degree as to render me unable to earn a support. I hereby claim pension under the law of June, 1890, hereon printed, and, revoking all other powers of attorney, I appoint Robt. A. Burton, Washington, D.C., my attorney with full power of substitution, to prosecute this claim. George W. (his X mark) McClain Witness: S.B. Holiman Jesa R. Allbritton =============================================================== MILITARY SERVICE Name of Soldier: George W. McClain So. Div. Bureau of Pensions, No. 1007262 July 10, 1891 Sir: It is alleged that the above named man enlisted Dec. 23, 1863 and served as a pri. in Co. E, 3 Reg't. Ark. Cav. and was discharged at Lewisburg, Ark. on June 30, 1865. The War Department will please furnish an official statement in this case, showing date of enrollment and date and mode of termination of service. Very respectfully, Andrew Davidson, Acting Commissioner =============================================================== War Department, Record and Pension Division Jul. 11, 1891 Respectfully returned to the Commissioner of Pensions. The rolls show that George W. McClain mentioned in the preceding indorsement, was enrolled Dec. 23, 1863 and M.O. with Co. June 30, 1865. By authority of the Secretary of War. F.C. Ainsworth =============================================================== George W. McClaine, Co. E, 3 Reg't. Arkansas Cav. appears on Company Descriptive Book of the organization named above. Description: Age 18 years; height 5 feet 6 inches Complexion light Eyes blue; hair light Where born Yell Co., Ark. Occupation Farmer Enlistment: When Dec 23, 1863 Where Yell Co., Ark. By whom Lt. Boles; term 3 y'rs. =============================================================== George W. McClane, Pvt., Co. E, 3 Reg't. Arkansas Cavalry appears on Company Muster Roll for Oct. 30 to Dec. 31, 1863 Joined for duty and enrolled: When Dec. 23, 1863 Where Yell Co., Ark. Period 3 years Present or Absent: Present Valuation of horse equipments, $25.00 Remarks: Pay due for use & risk of horse & horse equipment from Dec. 23, 63 to Dec. 31, 63. (Mustered in Dec. 30, '63 Little Rock) =============================================================== George W. McClane, Pvt., Co. E, 3 Reg't. Arkansas Cavalry appears on Company Muster Roll for Jan. & Feb. 1864. Joined for duty and enrolled: When Dec. 23, 1863 Where Scott Co., Ark. Period 3 years Present or Absent: Present Valuation of horse equipments: $26.61 Remarks: Pay due for use & risk of horse & horse equipments from Dec. 23, '63 to Feb. 29, '64 =============================================================== George W. McClane, Pvt., Co. E, 3 Reg't. Arkansas Cavalry appears on Company Muster Roll for Mar. & Apr. 1864. Joined for duty and enrolled: When Dec. 23, 1863 Where Scott Co., Ark. Period 3 years Present or Absent: Absent Valuation of horse equipments: $26.61 Remarks: Detached service Little Rock Mar. 23, 1864. Horse given out & left for want of forage. Pay due for use & risk of horse & horse equipments from Dec. 23, '63 to Apr. 30, '64 =============================================================== George W. McClane, Pvt., Co. E, 3 Reg't. Arkansas Cavalry appears on Company Muster Roll for May & June 1864. Joined for duty and enrolled: When Dec. 23, 1863 Where Scott Co., Ark. Period 3 years Present or Absent: Present Valuation of horse equipments: $26.61 Remarks: Pay due for use and risk of horse & horse equipments from Dec. 23, '63 to June 30, '64 =============================================================== George W. McClane, Pvt., Co. E, 3 Reg't. Arkansas Cavalry appears on Company Muster Roll for 30 Apl. to 31 Aug. 1864. Joined for duty and enrolled: When Dec. 23, 1863 Where Scott Co., Ark. Period 3 years Present or Absent: Present Valuation of horse equipments: $26.61 Remarks: Pay due for use and risk of horse & horse equipments from Dec. 23, '63 to Aug. 31, '64. Stop canteen & Haversack, sling & swivel. =============================================================== George W. McClane, Pvt., Co. E, 3 Reg't. Arkansas Cavalry appears on Company Muster Roll for Sept. & Oct. 1864. Joined for duty and enrolled: When Dec. 23, 1863 Where Scott Co., Ark. Period 3 years Present or Absent: Absent Valuation of horse equipments: $26.61 Remarks: Pay due for horse & equipments from Dec. 23, '63 to June 19, '64. Absent without leave. =============================================================== George W. McClane, Pvt., Co. E, 3 Reg't. Arkansas Cavalry appears on Company Muster Roll for Nov. & Dec. 1864. Joined for duty and enrolled: When Dec. 23, 1863 Where Scott Co., Ark. Period 3 years Present or Absent: [Blank] Valuation of horse equipments: $26.61 Remarks: Pay due for horse and horse equipments from Dec. 23, '63 to June 19, '64 =============================================================== George W. McClane, Pvt., Co. E, 3 Reg't. Arkansas Cavalry appears on Company Muster Roll for Jan. & Feb. 1865. Joined for duty and enrolled: When Dec. 23, 1863 Where Scott Co., Ark. Period 3 years Present or Absent: Present Valuation of horse equipments: $26.61 Remarks: Pay due for use & risk of horse & horse equipments from Dec. 23, '63 to June 19, '64 =============================================================== George W. McClane, Pvt., Co. E, 3 Reg't. Arkansas Cavalry appears on Company Muster Roll for Mch. & Apl. 1865. Joined for duty and enrolled: When Dec. 23, 1863 Where Scott Co., Ark. Period 3 years Present or Absent: Present Valuation of horse equipments: [Blank] =============================================================== G.W. McClane Co. E, 3 Reg't. Arkansas Cavalry appears on Returns as follows: Sept. and Oct. 1864 Absent without leave since Sept. 8, '64 =============================================================== George W. McClane, Pvt., Co. E, 3 Reg't. Arkansas Cavalry. Age 18 years. Appears on Co. Muster-out Roll, dated Lewisburg, Ark. June 30, 1865 Muster-out to date June 30, 1865 Last paid to Feb. 28, 1865 Clothing account: Last settled Dec. 31, 1864; drawn since $53.07 Due U.S. for arms, equipments, &c, $1.02 " " " " ordnance, $8.00 Remarks: Stop for canteen 65 cents, 1 can, screw driver 37 cents. ================================================================ 3d ARKANSAS CAVALRY General Notation War Department, Adjutant General's Office, Washington, D.C., September 2, 1873. The private horses of the enlisted men of this regiment were purchased by the Government under S.O. No.162, Head Quarters Department of Arkansas, July 12, 1864, on or about October 1, 1864. ================================================================ GENERAL AFFIDAVIT State of Arkansas, County of Hot Spring, SS: In the matter of Pension Claim No. 1007262 of George W. McClain On this 12 day of February A.D. 1892 personally appeared before me a Notary Public in and for the aforesaid County duly authorized to administer oaths, George W. McClain, aged 46 years, a resident of Magnet in the County of Hot Spring and State of Arkansas whose Post Office address is Magnet, Arkansas, well known to me to be reputable and entitled to credit, and who, being duly sworn, declared in relation to aforesaid case as follows: That I am the identical person who has filed Pension Claim No. 1007262 and in addition to the causes alleged therein for pension states that in the fall of the year 1865 I contracted Ichetis[?] or swelling of the testicles, that said cause of disability is not alleged in my former declaration heretofore filed under the act of June 20, 1890 and that such disability is not due to vicious habits and is to the best of my knowledge and belief of a permanent character. George W. (his X mark) McClain Witnesses J.L. Hardwick M.H. Doty ================================================================= Department of the Interior, Bureau of Pensions, Washington, D.C., July 16, 1894 Respectfully referred to the Chief of the Record and Pension Office, War Department, requesting a full military and medical history of the soldier. Please examine all records likely to afford any information as to diseases, wounds, or injuries incurred by him while in the service. No other reports on file. Cert. No. 736367 Name: George W. McClain, Co. E, 3 Reg't. Ark. Vol. Cav. ================================================================= Record and Pension Office, War Department. Respectfully returned to the Commissioner of Pension. George W. McClane, Co. E, 3 Reg't. Ark. Cav. was enrolled Decr. 23, 1863 and M.O. June 30, 1865. The name George W. McClain has not been found on the rolls of Co. E, 3rd Regt. Ark. Cav. From Dec. 23 1863 to June 30, 1865 he held the rank of Privt. and during that period the rolls show him present except as follows: Apr 30/64 Detached Serv. Little Rock. Mar. 23, 1864 - Oct. 31/64 "Absent without leave since Sep. 8/64 - Dec. 31/64 Pres. or Abs. Not stated. The medical records show him treated as follows: No record found. ================================================================= NEIGHBOR'S AFFIDAVIT [Undated but stamped 22 September 1894] State of Arkansas, County of Garland, SS: In the Pension Claim No. 736367 of George W. McClain late private Co. E, 3 Reg't. Ark. Cav. Vols., personally came before me, a Notary Public in and for the aforesaid County and State Robert L. Kimzey, who I hereby certify is a respectable and credible person, who, being duly sworn, declares in relation to the aforesaid claim that his age is 28 years, and that he has known the above-named soldier since 1884, that he first saw said soldier after his discharge from the military service of the United States on or about the [blank] day of August 1884 at Scott Co., Ark., and his physical condition is as follows: His left arm is stiff at the elbow, and almost entirely useless from rheumatism and he is ruptured in the right side all of which renders him almost totally unable to perform manual labor and his condition now is and has been for years past incapacitates him from manual labor to earn a living. I know these facts from being a neighbor to him and seeing him almost daily, and have labored together and that this statement is written by J.H. Scroggins, notary public, at his office in the Gould Block, Hot Springs, Arkansas at my request and from my oral statements made to him and he [is] writing them down in my presence without any written or printed statement or [word] furnished by anyone and from facts as I know them from understanding and memory above. He further declares that his post-office address is Magnett, County of Hot Spring, State of Arkansas and that he is not interested in said claim or concerned in its prosecution. Robt. L. Kimzey ================================================================== Department of the Interior, Bureau of Pensions, Washington, D.C., January 15, 1898. Certificate No. 736367 Name: George W. McClain 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, M. Clay Evans George W. McClain Jessieville, Garland Co., Ark. First. Are you married? If so, please state your wife's full name and her maiden name. Answer: Yes, Martey McLane Second. When, where, and by whom were you married? Answer: Louisburg, Conway Co., Ark., Rev. [illegible] Third. What record of marriage exists? Answer: August 3, 1865 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: No Fifth. Have you any children living? If so, please state their names and the dates of their birth. Answer: Yes, Frank McClain, March 17, 1879, Sarah McClain, August 28, 1874. Geo. W. McClain Date of reply, August 3, 1898. =================================================================== GENERAL AFFIDAVIT [Undated, stamped 31 August 1899] State of Arkansas, County of Garland, SS: Personally appeared George W. McClain, aged 55 years of Hot Springs P.O., County of Garland, State of Arkansas who, being duly sworn upon his oath declares as follows: I am the claimant in Application No. [blank] for increase of Invalid Pension the disability of vericocele[?] that I am claiming increase for existed when I made my application for Pension under Law of '90 yet this disability was incurred in the line of duty during my service but the only comrades that knew when, where and under what circumstances the disability was incurred having died, they all died before 1890, their names were John McClain, Joseph Bance[?], John Hawkins, the two first named belonged to my Company, John Hawkins belonged to a Battery. I showed them my injury after we returned off the Camden (Ark.) raid in Jan. 1864 it was done during the 21 days of continuous riding, raiding & fighting. I am unable to furnish any evidence of any comrade that knew of this injury as I do not recollect of any other comrade now living that I showed this injury to. ===================================================================== GENERAL AFFIDAVIT [Undated, stamped 30 September 1899] State of Arkansas, County of Garland, SS: In the matter of pension claim for increase of George W. McClain late of Co. E, 3rd Arkansas Cavalry. Personally came before me, a Notary Public in and for the aforesaid County and State, George H. Berry, aged 55 years and Michael Archer, aged 68 years, citizens of the town of Hot Springs, County of Garland, State of Arkansas, well known to me to be reputable and entitled to credit, and who, being duly sworn, declare in relation to aforesaid case as follows: We are personally acquainted with George W. McClain and have been for the last seven or eight years. During said time he has suffered with hernia, rheumatism, neuralgia and scurvey. His left arm is atrophied so it is not more than half as large as the right arm and it appears to have but very little strength in it. He appears to suffer also with a disease of the stomach and chronic diarrhea which confines him to his bed a considerable portion of the time. He is to the best of our knowledge permanently disabled from earning a support by manual labor and said injuries we do not think are the result of vicious habits. We gain our information by being well acquainted with him and living near him and seeing him almost daily for years. He is disabled more or less from work all the time but some of the time entirely and part of the time he can go around and do light work. We further declare that we have no interest in said claim and we are not concerned in its prosecution. George H. Berry Michael Archer ================================================================= DROP ORDER AND REPORT Department of the Interior, Bureau of Pensions, Finance Division. Washington, D.C., Sep. 15, 1905 George W. McClain, Certificate #736367 Invalid Class Co. E, 3 Ark. Cav. U.S. Pension Agent, Knoxville Sir: You are hereby directed to drop from the roll the name of the above described pensioner who died July 5, 1905. ================================================================= WIDOW'S APPLICATION FOR ACCRUED PENSION State of Arkansas, County of Garland, SS: On this 8 day of August, 1905, personally appeared Martha S.A. McClain, who being duly sworn, declares that she is the lawful widow of George W. McClain, deceased; that he died on the 5th day of July, 1905, that he had been granted a pension by Certificate No. 736367 which is herewith returned; that he had been paid the pension by the Pension Agent at Knoxville up to the 4 day of May 1905, after which date he had not been employed or paid in the Army, Navy, or Marine service of the United States, except Co. E, 3 Ark. Cav; that she was married to the said George W. McClain on the 3 day of August 1865 at Lewisburg, in the State of Arkansas; that her name before said marriage was Martha S.A. McClain; that she had not been previously married; that her husband had not been previously married; that she hereby makes application for the pension which had accrued on aforesaid certificate to the date of death; and that her residence is P.O. Box 341, City of Hot Springs, County of Garland, State of Arkansas and her Post-Office address is given above. She hereby appoints herself, of Hot Springs, Ark., her attorney to prosecute this claim and directs that [blank] be paid the legal fee. Martha (her X mark) S.A. McClain Witness to mark: E.A. Nickels Maud M. Kimzey Also personally appeared Maud M. Kimzey, residing at Hot Springs, Ark. and George H. Berry, residing at Hot Springs, Ark., who, being duly sworn, say that they were present and saw Martha S.A. McClain sign her name (make her mark) to the foregoing declaration; that they know her to be the lawful widow of George W. McClain, who died on the 5 day of July 1905, and that their means of knowledge that said parties were husband and wife, and that the husband died on the said date, are as follows: We were well acquainted with deceased soldier during his life time and attended his funeral and know that they were husband & wife & know that they lived together as husband & wife to date of soldier's death. Maud M. Kimzey Geo. H. Berry ================================================================== DECLARATION FOR WIDOW'S PENSION State of Arkansas, County of Garland, SS: On this 8 day of August, A.D. one thousand nine hundred and five personally appeared before me, a Notary Public within and for the County and State aforesaid, Martha S.A. McClain, aged 63 years, a resident of Hot Springs, Ark., County of Garland, State of Arkansas, 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 June 27, 1890, as amended by the Act of May 9, 1900. That she is the widow of George W. McClain who was enrolled under the name of George W. McClain at [blank] on the 15 day of October 1863 as a Private in Co. E, 3 Ark. Cav. Vols. and honorably discharged June 30, 1865, having served ninety days or more during the late war of the rebellion. That the soldier was not in the military or naval service of the United States except as stated above. No other service. That she was married under the name of Martha S.A. McClain to said soldier George W. McClain on the 3 day of August 1865 by Rev. Moring; that there was no legal barrier to the marriage; that she had not been previously married; that the soldier had not been previously married. That the said soldier died July 5, 1905 at Hot Springs, Ark; that she was not divorced from him; that she has not remarried since his death; and that she is without other means of support than her daily labor and an actual net income not exceeding two hundred and fifty dollars per year. That the said soldier left the following-named children who are now living and under sixteen years of age, to wit: No children under 16 years of age now living. That she has not heretofore applied for pension. That she hereby appoints herself of Hot Springs, Ark. her true and lawful attorney to prosecute this claim. That her post- office address is P.O. Box 34, Hot Springs, Ark. Martha (her X mark) S.A. McClain Geo. H. Berry Maud M. Kinzey ================================================================== GENERAL AFFIDAVIT State of Arkansas, County of Garland, SS: In the matter of claim for Pension Martha S.A. McClain widow of Geo. W. McClain, Co. E, 3 Ark. Cav. On this 14 day of August, A.D. 1905, personally appeared before me a Notary Public in and for the aforesaid County, duly authorized to administer oaths Martha S.A. McClain, aged 63 years, a resident of Hot Springs, Ark., in the county of Garland and State of Arkansas well known to be reputable and entitled to credit, and who, being duly sworn, declared in relation to aforesaid case as follows: I am the claimant in above entitled claim and am the widow of Geo. W. McClain who served as Private in Co. E, 3 Ark. Vol. Cav. who died at Hot Springs, Ark. on the 5 day of July 1905. I lived with soldier to day of his death we were married on the 3 day of Aug. 1865 by Rev. A. Moring in Conway County Arkansas. I have no one legally bound for my support. I own no real or personal property. I have no money in bank. I have no stocks, bonds or other evidences of indebtedness. I have no income from any source whatever. I am unable to see to walk without the aid of another person, being almost totally blind which prevents me from earning a support by my own labor. I have not remarried. I ask that my claim be put in the hands of a special examiner to visit Conway County & procure evidence of my marriage. I have written to the parties who were present but they have not responded. Martha (her X mark) S.A. McClain E.A. Nickels, Jr. S.F. Shockley ==================================================================== GENERAL AFFIDAVIT State of Arkansas, County of Scott, SS: In the matter of Martha S.A. McClain, widow of George W. McClain, No.736367 Co. E, 3d Ark. Cav. On this 17 day of August, A.D. 1905, personally appeared before me, S.G. Ray a Justice of the Peace in and for the aforesaid County, duly authorized to administer oaths Nannie Hinton, aged 73 years, a resident of Blansett Township in the County of Scott and State of Ark. whose Post-office address is Blanset and Misaniah Lovett, aged 53 years, a resident of Blansett Township, in the County of Scott and State of Arkansas, whose Post-office address is Blansett, Scott Co., Ark. well known to be reputable and entitled to credit, and who, being duly sworn, declared in relation to aforesaid case as follows: I have known Martha S.A. McClain who is now the widow of George W. McClain, Dec'd. When I first became acquainted with her she was about 20 or 21 years of age. She had never been married until she married the soldier George W. McClain, deceased, who I have known ever since he was a child and know that he never was married until he married Martha S.A. McClain. That was her name before she married her husband of the same name, they was no relation before they married and I Misaniah Lovett corroborate all the facts set forth in the affidavit of Mrs. Nannie Hinton. I knew both the parties named above Martha S.A. McClain I also knew the soldier George W. McClain deceased before they were married and know that neither of them were married before they married each other. Mrs. Nannie Hinton partly raised Geo. W. McClain deceased from a child. We further declare that we have no interest in said case and are not concerned in its prosecution. Nannie Hinton Misaniah Lovett ================================================================ NEIGHBOR'S AFFIDAVIT State of Arkansas, County of Garland, SS: In the matter of the application for pension Claim of Martha S.A. McClain, widow of George W. McClain. On this 9th day of April A.D. 1906 personally appeared before me a Notary Public in and for the aforesaid County, duly authorized to administer oats, Martha S.A. McClain, aged 64 years, a resident of Garland County and State of Arkansas whose Post- Office address is Genl. Del., Hot Springs, Ark. [and] J.L. May aged 58 years, a resident of Hot Springs in the County of Garland and State of Ark. whose Post-Office address is Hot Springs, Genl. Del. well known to me to be respectable and entitled to credit, and who, being duly sworn, declare in relation to the aforesaid case as follows: I am the claimant and have furnished the affidavits of Nancy Hinton and Mrs. Blanset Lovitt also Dr. Thompson the physician that attended on him during his last illness. He my husband the soldier died on the 5th day of July 1905 & buried on the 8th. Now I am dependent upon charity for my support and am living at the residence of a neighbor. I am unable to see & can only walk by the aid of another person & I ask that my claim be made special and placed in the hands of a Special Examiner with instructions to close it up at once. I can be found at East end of Silver (no number) Street at the residence of J.L. May within city limits. I, J.L. May, being duly sworn say I am acquainted with the claimant, Martha S.A. McClain. I fully corroborate her statement as to having no one to depend upon for support, her daughter moved away and left her at my house about six weeks ago. She has no real or personal property of any value. She is an object of charity no one is legally bound for her support. She would be in the poor house or county farm if some of the neighbors did not give her shelter. She has to be led about as she is almost totally blind. Her son is somewhere in California. She has not attorney of record and her case should be looked after & made special by the govt. She is 64 years old & blind & a pauper. Martha (her X mark) S.A. McClain J.L. May E.A. Nickels L.J. May State of Arkansas, County of Garland Sworn to and subscribed before me this day by the above- named affiant, and I certify that I read said affidavit to said affiant and acquainted her & him with its contents before they executed the same. I further certify that I am in nowise interested in said case, nor am I concerned in its prosecution; and that said affiants are personally known to me and that they are credible persons. E.A. Nickels, Notary Public ================================================================ APPLICATION FOR REIMBURSEMENT State of Arizona, County of Maricopa, SS: On this 13th day of November A.D. 1928, before me, the undersigned, personally appeared Mrs. Sadie Cranford, aged 53 years, a resident of Phoenix, County of Maricopa, State of Arizona, who makes the following declaration as an application for, and claim is hereby made for, reimbursement from the accrued pension for expenses paid (or obligations incurred) in the last sickness and burial of Martha S.A. McClain, who was a pensioner of the United States by certificate No. 610744 and who died July 24, 1928 at Phoenix, Arizona and was buried at Phoenix, Arizona. That the answers to questions propounded below are full, complete, and truthful to the best of my knowledge, information and belief, and that no evidence necessary to a proper adjustment of all claims against the accrued pension is suppressed or withheld. 1. What was the full name of the deceased pensioner? Martha Sarah Ann McClain 2. In what capacity was decedent pensioned? Widow 3. [Not applicable] 4. Did pensioner leave a child under 16 years of age? No 5. Is any such child still living? ----- 6. Were any sick or death benefits paid on pensioner's account? If so, give name of society and amount paid: First Baptist Church of Phoenix gave $21.00 7. Was there insurance (life, accident or health) in force on life of pensioner at time of death? No 8. If so, give the name of each company in which a policy was carried and the amount in which each policy was written. ------ 9, 10, 11, 12 [Not applicable] 13. Is there an executor or administrator, or will application be made for appointment of any person as administrator? No 14. Did the deceased pensioner leave any money, real estate, or personal property? No 15, 16, 17 [Not applicable] 18. Did pensioner leave an unindorsed pension check? No 19. What was your relation to the deceased pensioner? Daughter 20. Are you married? No (widow) 21. What was the cause of pensioner's death? Pneumonia 22. When did the pensioner's last sickness begin? July 21, 1928 23. From what date did the pensioner become so ill as to require the regular and daily attendance of another person constantly until death? Was helpless invalid for about 13 months before death. 24. Give the name and post office address of each physician who attended the pensioner during last sickness. Dr. Couch, Phoenix, Arizona 25. State the names of the persons by whom the pensioner was nursed during the last sickness. Myself (Mrs. Sadie Cranford) 26. Where did the pensioner live during last sickness? Phoenix, Arizona. 27. Has there been paid, or will application be made for payment to you or any other person, any part of the expenses of the pensioner's last sickness and burial by any State, county, or municipal corporation? No The following is a complete statement of all the expenses of the last sickness and burial of said deceased pensioner: Dr. Garland B. Couch, Physician, Not Paid, $54.00 J.T. Whitney, Undertaker, $91.00, Paid $31.00 Total $145.00 That of the above mentioned expenses this claimant has paid, or guaranteed the payment of, the following items: has paid $31.00 to undertaker and has guaranteed payment of all remaining bills. Mrs. Sadie Cranford Route 1, Box 404 Phoenix, Arizona Also appeared Mistress Tryphena A. Vaughn and Mrs. L.P. Smith who, being duly sworn, make the following statement, each for himself, that they know the claimant herein and that their answers to the following questions are true: 1. Did pensioner (if a soldier or sailor) leave a widow or a minor child under age of sixteen years surviving? No 2. When did the pensioner die? July 24, 1928 3. Did pensioner leave any property? No 4. Our means of knowledge of the above statements made by us are: We knew the deceased for 2 years and Mrs. Vaughn lived across the street from her during that time. Mrs. Smith lived about 2 blocks away. Mrs. Tryphena A. Vaughn, P.O. Address Phoenix, Arizona Mrs. L.P. Smith, P.O. Address Phoenix, Arizona Subscribed and sworn to before me, this 14th day of November A.D. 1928; and I certify that the contents of the foregoing application were fully made known and explained to the claimant and witnesses before swearing, that I have no interest, direct or indirect, in the prosecution of this claim, and I further certify that the reputation for credibility of the witnesses whose signatures appear above is good. Marcia Davenport, Notary Public, Phoenix, Arizona STATEMENT OF ATTENDING PHYSICIANS Give pensioner's name in full: Martha S.A. McClain Give date of commencement of pensioner's last sickness: July 20th 1928 Give date of pensioner's death: July 24th 1928 From what date did the pensioner require the regular and daily attendance of another person constantly until death? July 19th 1928 to July 24 During what period did you attend the pensioner? From Jany. 10th 1928 to July 24 1928 State nature of disease from which pensioner died: Pneumonia Give name of any other physician who attended the pensioner in last sickness: [Illegible] Does your bill include a charge for all medicine furnished the pensioner during last sickness? Yes Has your bill been paid; if so, by whom? No Give the name of each person who acted as nurse, and mention any other facts within your knowledge which would be helpful in adjusting this claim for reimbursement: Sadie Cranford, daughter of patient. I certify that the foregoing statement is correct. Garland B. Couch 11-10-1928 ===================================================================