Rachel Riley Amis' DECLARATION FOR WIDOW'S PENSION
(To be executed before a court of record or some officer thereof having custody of its seal.)

STATE OF KANSAS, COUNTY OF KIOWA SS:
On this 4th day of Sept A. D. one thousand eitht hundred and ninety..........., personally appeared before me, A.N. Reed (his signature) Notary Public on file in ? within and for the county and State aforesaid, Rachel Amis, aged 45 years, a resident of the city of Mullinville, county of Kiowa, State of Kansas, who being duly sworn according to law, declares that she is the widow of Wiley Amis, who enlisted under the name of Wiley Amis, at..................on the ............day of........,18....., in 14th Kentucky Cavalrey US Lieut
(Here state rank, company and regiment, in military service, or vessel if in the Navy)
and served at least ninety days, in the late war of the Rebellion, who was honorably discharged on the .........day of ........,18.....and died, on the .......day of......, 18.........
(The cause of death need ?be stated)

That she was married under the name of Rachel Riley to said Wiley Amis on the ? day of June, 1876, by Rev. Robt Burton (in or near CrocketVille, P.O. Brethitt Co. Ky., there being no legal barrier to said marriage......, Wiley Amis had ? married before this marriage and dissolved by death,(of wife)

That she has not remarried since the death of the said husband.
(Name of soldier or sailor.)
That she is without other means of support than her daily labor: that names and dates of birth of all the children now living under sixteen years of age of the soldier are as follows:
Squire Amis, born July 22, 1878
David Amis, born Aug 7, 1880
Rachel Amis, born Dec 8, 1852
That she has heretofore applied for pension and the number of her application is .............
(be careful to fill this part of the blank correctly.)
That she makes this declaration for the purpose of being placed on the Pension-roll and lawful attorney to prosecute her claim. (he to receive a fee of $10.00) That her post-office address is Mullinville, county of Kiowa, State of Kansas
her
Rachel X Amis
mark

Attest: A.N. Reed

Also personally appeared H.W. Hodges, residing at Mullinville, Kansas and J. W. Hank residing at Mullinville, Kansas, persons whom I certify to be respectable and entitled to credit, and who, being by me duly sworn, say they were present and saw Rachel Amis, the claimant, (sign her name marked out )} (or make her mark to (the foregoing declaration: that they have every reason to believe from the appearance of said claimant and their acquaintance with her for 5 years and 3 years, respectively, that she is the identical person she represents herself to be: and that they have no interest in the prosecution of this claim.

H W Hodges
J W Hank

(signatures of witnesses.)

Sworn to and subscribed before me this 6 th day of Sept, A.D. 1890, 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 (sign her name) erased, and the words ?? added; and that I have no interest direct or indirect, in the prosecution of this claim.

A.N. Reed

(signature)

Notary Public

(official character)

(?????? expires Dec 20, 1890)


Transcription by Nancy Frost Moulton from material from the Clay County Historical Society. Made available to this website by Sherry Baker Frazier
Owsley Co. Historical Society .