Swore he served 90 days in the War of the Rebellion. Enlisted at Chicago, Illinois, in July 1865.
Also [in printed language of form], "That he is at this time afflicted with a disability which is not the result of his own vicious habits, and as he verily believes in permanent in character."
Specifically [as blanks are filled in], he is "incapacitated three fourths of the time" due to "diseased conditions of the right lung and liver."
The form for filing is a printed one supplied by "T.W. Tallmadge, of Washington, D.C., his true and lawful attorney to prosecute this claim . . . & receive a fee of $10.00."
When & where married? "1867 . . . by Lutheran Minister, [town indecipherable], Holt Co Mo"
"Not previously married"
Any childen living? "Yes. Vera 1871 [next indecipherable] Lena 1878 Henry 1880 William 1885"