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Form 17
SPECIAL NOTICE--The civil officer before whom this affidavit is executed should be careful to fill in all spaces, both in the caption and jurat.
GENERAL AFFIDAVIT
STATE OF [crossed out] County of [crossed out] District of Columbia........ss:
In the matter of pension claim of Catherine, widow of John Kelly, late Co. K, 4' U.S. Infantry
On this 2nd day of February, A.D. 1912, personally appeared before me a notary public in and for the aforesaid County [crossed out] Dist., duly authorized to administer oaths, John McKenny aged 79 years, a resident of Washington, D.C. in the County of [crossed out], and State of [crossed out] whose post office is 1505-11th Str. N.W., Washington, D.C. well known to be reputable and entitled to credit, and who, being duly sworn, declared in relation to aforesaid case as follows:
That he was personally acquainted with the late John Kelly before his marriage, on January 1, 1866, to affiant's sister, his present widow, Catherine Kelly, and has personal knowledge that neither the said John Kelly or the said Catherine Kelly were ever married previous to their marriage to each other. Affiant also knows that the parties named lived together continuously as husband and wife from the date of their said marriage to the date of John Kelly's death, and that they were never divorced from each other.
He further declares that he has no interest in said case and is not concerned in its prosecution.
John McKenny
Signature of Affiant
State of [crossed out] District of Columbia......ss
Sworn to and subscribed before me this day by the above named affiant, and I certify that I read said affidavit to said affiant, including the words [none] erased, and the words [none]added, and acquainted him with its contents before he 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 affiant is personallyknown to me and that he is a credible person.
[L.S.]
W. H. Robbins
(Official Signature)
Notary Public
(Official Character)
To be executed before a Court of Record or some officer thereof having custody of its seal, a Notary Public, or Justice of the Peace, whose official signature shall be verified by his official seal, and in case he has none, his signature and official character shall be certified by a Clerk of a Court of Record, or by a City or County Clerk, unless such certificate is already on file in the Pension Office, when such fact should be stated. |
