Page 1
Applicant - Josephine A WHEELER, sister of
Veteran - John A JACOBS
Can No. 1420 Bundle No. 29
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State of Kentucky }
County of Green }
On this the 20th day of September 1878 personally appeared before me James BALE, who being duly sworn according to law deposed and says that he is and has been well acquainted with Alpha JACOBS for three years and has been his neighbor and lived about one mile from him and during his acquaintance with the said Alpha JACOBS he has been in the company of him very frequently and has had good opertunity (sic) of knowing his pysical (sic) condition and during the whole period of his acquaintance with the said Alpha JACOBS at no time has he been able on account of old age diseas (sic) and injuries has he been able to make a support for himself and family by manual labor and the family of the said Alpha JACOBS being very poor they not being the possessors of either real or personal property to the amount of one hundred dollars, and that he has no interest in the prosecution of any claim. James BALE


Sworn to and subscribed before me on the day and year first above writeen and I certify that the affiant James BALE is a credable (sic) witness. J P Cunningham, JPGC.
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State of Kentucky}
County of Green }Sct I, AJ PERKINS, Clerk of the Green County Court certify that JP Cunningham is a Justice of the Peace for Green County is duly commissioned and qualified that his commission was dated on the 15th day of May 1875 and will expire on the 15th day of May 1879. And that his signature within written is genuine. Given under my hand and Seal of said court this 24th day of October 1878. A J Perkins, clerk
(Along side of page)
Case of Jane JACOBS mother
of
John A JACOBS, priv.
Co G 6th KY Cav Vol
Apl 1875
For Pensioner -
Disability
Property
Affidavit of James BALE

Filed by Saml BELDIN
Lebanon, KY

Stamped by: Department of the Interior Pension Office Oct 28, 1878
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State of Kentucky}
County of Green }
On this the 20th day of Sept 1878 Personally appeared before me P W SANDIDGE who being duly sworn according to law deposes and says that he is and has been well acquainted with Alpha JACOBS and has been for three years and has been his neighbor and lived about 1/2 mile from him and during his acquaintance with the said Alpha JACOBS he has ben in the company of him very frequently and has good opportunities of knowing his physical condition and during the whole period of his acquaintance with the said Alpha JACOBS at no time has he been able on account of old age, disease and injuries has he been able to make support for himself & family by manual labor and the family of the said Alpha JACOBS being very poor they not being the possessors of either real or personal property to the amount of one hundred dollars, and that he has no interest in the prosecution of any claim. P W SANDIDGE

Sworn to and subscribed before me on the day and year first above written and I certify that the affiant P W SANDIDGE is a credable (sic) witness. J P Cunningham, JPGC.
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Page 5

State of Kentucky}
County of Green }
I, A J Perkins Clerk of the Green County Court certify that J P Cunningham is a Justice of the Peace for Green County is duly commissioned and qualified that his commssion was dated on the 15th day of May 1875 and will expire on the 15th day of May 1879 and that his signature within written is genuine given under my hand and seal of said court this 24th day of October 1878. A J Perkins, Clerk
(written along side of page)
Case of Jane JACOBS mother of
John A JACOBS, Private
Co G 6th KY Cav
Augt 1875
For pension - disability
Affidavit of P M SANDIDGE
Filed by Saml BELDEN
Lebanon, KY

Stamped by: Department of the Interior Pension Office Oct 28, 1878
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Page 6

General Affidavit
State of Kentucky}
County of Marion } In the matter of Mrs Jane JACOBS as he understands is an applicant for dependent Pension on the death of her son John A JACOBS, Co G 6th KY Cav Vol. Personally came before me, a County Court Clk. in and for aforesaid County and State, citizen of the County of Marion, State of Kentucky, well known to me to be reputable and entitled to credit, and who, being duly sworn, declare in relation to aforesaid case, as follows: The (sic) he has made an examination of Alpha JACOBS the husband of Mrs Jane JACOBS and father of John A JACOBS and find his condition as follows: age 78 - height 5 ft. 7 1/2 in. - complexion fair, respiration 20 - pulse 72. I find considerable tenderness & enlargement in the region of the right kidney, ranging around over the sut (?) of the __iren?, on measuring from center of spine to naval on each side I find a difference of about two inches greater on right than on left. I find the right shoulder some what lower than left. The scapular end of clavicle & acromion (?) process of scapular has been broken and the muscular stratum around the joint injured to such an extent that he has not much use of the arm. I find that he is incapacitated for obtaining his support by manual labor, full 3/4, taking in consideration his age & amount of his injuries. I further declare that I have no interest in said case, and am not concerned in its prosecution. Signature of Affiants: R O McCHORD, M.D.
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General Affidavit (its 2nd page)
Sworn to and subscribed before me this day by the above named affiant: and I certify that I read said affidavit, 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 Dr. R O McCHORD is a practicing physician and reputable in his profession.
Witness my hand and official seal this 13 day of Sept 1878 Sign here: John SEVERANCE Clerk Marion County Court
(along side of page)
Disability
1878 M D
Case of Jane JACOBS mother of John A JACOBS Co G., 6 KY Cav.
for Pension
Affidavit of Dr R O McCHORD
Filed by Samuel BELDEN
Lebanon, KY
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Stamped: Recieved Adjutant General's Office Dec 9, 1878
Widow's Division Department of the Interior Pension Office
Decr. 5, 1878

Sir: You are respectfully requested to furnish official evidence of the enrollment , muster, service, duty, and discharge or death of John A JACOBS, who was a Private in Company G, 6 Regiment of KY Cav. Vols., reported lost on Str. SULTANA near Memphis, Tenn. Apr. 27, 1865. If the above name is not found on the rolls of said Company, will you so state, and report as to enrollment, &c., in the case of any man bearing a similar name, whom you have good reason for believing to be the soldier inquired for. Please, also, to furnish and evidence on file that may enable this Office to decide whether the soldier's death resulted from injuries received or disease contracted in the service and line of duty. Please give full military history. Please return this circular with your report. Claim No. 240006 Very respectfully, J A Bentley, Commissioner

Adjutant General, U.S.A.
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Washington D.C., January 31, 1879

Sir: I have the honor to acknowledge the receipt from your Office of application for Pension No. 240.006, and to return it herewith, with such information as is furnished by the files of thie Office. It appears from the Rolls on file in this Office that John A JACOBS was enrolled on the 5th day of August 1862, at Liberty in Co. G, 6th Regiment of Kentucky Cavalry Volunteers, to serve three years or during the war, and mustered into service as a Private on the 15th day of September, 1862, at Louisville, KY, in Co. G, 6th Regiment, during the war. On the Muster Rolls of Co. G, of that Regiment, to October 31, 1863, he is reported present. Nov & Dec absent, missing in action September 21, 1863 (when the Company was in action at Chickamauga, GA). Same to February 28, 1865. March & April 1865, Private, killed on SULTANA April 28, 1865. Prisoner of War Record show J _ Jno _ or J A JACOBS said Co. and Regt. captured at Chickamauga, GA Sept 19, '63. Conf'd at Andersonville, GA date not given. Paroled (sic) at Vicksburg, Miss. on or about Apl. 21, '65 and perished on Board Steamship SULTANA Apl. 27, '65. Apl 27/65 is accepted as the correct date of death. This report is accepted as referring to John A JACOBS Co. G, 6th KY Cav. I am, sir, very respectfully, Your obedient servant, S V Benjamin, Assistant Adjutant General
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General Affidavit
State of Kentucky County of Casey In the matter of Pension Claim of Joesphine WHEELER. On this 21st day of January A.D. 1893, personally appeared before me, a Justice of the Peace in and for the aforesaid County, duly authorized to administer oaths, John F WHEELER aged 29 years, a resident of Liberty in the County of Casey and State of Kentucky well known to me to be reputable and entitled to credit, and who being duly sworn, declares in relation to aforesaid case as follows:
[Note: Affiants should state how they gain a knowledge of the facts to which they testify.]
I was present at the death of both the parents of the claimant, the father died August the 9th 1884 the mother died Jan the 1st 1882.

His post office address is Liberty Casey County Kentucky, further declares that I have no interest in said case and are not concerned in its prosecution. ohn F WHEELER. $Signature of Affiant]
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State of Kentucky, County of Casey 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 ____________(left open)____________ erased, and the words ____________(left open)____________ added and acquainted him with its contents before I executed the same. I further certify that I am in no wise interested in said cases, nor am I concerned in its prosecution; and that said affiant is personally known to me and that he is a credible person.  S KING [Official Signature] .P.C.C. KY [Official Character]

Stamped as received by U S Pension Office Feb 16, 1893

State of Kentucky}
Co of Casey } I, A G Prewitt, Clerk of the County Court for the County and State aforesaid do certify that M S King, Esq, who has signed his name to the foregoing Jurat? wa at the time of so doing a Justice of the Peace in and for said County and State duly commissioned and sworn, and that all his official acts are entitled to full faith and credit and that his signature written thereto is genuine. Witness my hand and seal of office this Jany 25, 1893.  A Prewitt (Clerk) y A P Young (D.C.)
(along side of page)
No. 423647
General Affidavit
Claim of Josephine JACOBS for sister's pension John A JACOBS Co. G 6th KY Cav.
Filed by E H Gelston & Co. Attorneys,
P.O. Box 725 Washington D.C.
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General Affidavit
State of Kentucky County of Casey In the matter of Pension Claim of Josephine WHEELER. On this twenty first day of January A.D. 1893 personally appeared before me, a Justice of the Peace in and for said County, duly authorized to administer oaths, Mary A WHEELER aged 70 years, a resident of Liberty in the County of Casey and State of Kentucky well known to me to be reputable and entitled to credit, and who being duly sworn, declares in relation to aforesaid case as follows:
[Note: Affiants should state how they gain a knowledge of the facts to which they testify.]
I was present when the father and mother of the claimant both died the mother died Jan the 1st 1882 the father died August the 9th 1884.
Her post office address is Liberty Casey County Kentucky futher declares that I have no interest in said case and are not concerned in its prosecution.
John F WHEELER
Mary F WHEELER ary A x WHEELER
[If affiant signs by mark, $Signature of Affiant]
two persons who can write
sign here.]
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State of Kentucky, County of Casey 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 ______(left open)_______ erased, and the words _______(left open)________ added and acquainted her with its contents before I executed the same. I further ceritfy that I am in no wise interested in said case or its prosecution; and that said affiant is personally known to me and that she is a credible person.  S King [Official Signature] .P.C.C. KY [Official Character]

State of Kentucky}
Co of Casey } I, A G Prewitt Clerk of the Casey County Court do certify that M S King Esq. who has signed the foregoing Jurat? was at the time of so doing a Justice of the Peace in and for said County and State duly commissioned and sworn and that all his official acts are entitled to full faith and credit and that his signature written thereto is genuine. Given under my hand and seal of office this Jany 25th 1893.  A Prewitt Clerk y A P Young D.C.
(along side of page)
No. 423647
General Affidavit
Claim of Josephine WHEELER for sister's pension John A JACOBS
Co G 6th KY Cav
Filed by E H Gelston & Co. Attorneys'
P.O. Box 725 Washington D.C.

Stamped received by U S Pension Office Feb 16, 1893
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Page 14

State of Kentucky}
County of Casey }

On this 5th day of November 1880 personally appeared before me County Court Clerk of County and State aforesaid, Eliza J DOW and Geo W EARLS of Casey County to me well known as persons of good character whose oaths are entitled to full faith and credit being by me duly sworn according to law depose and say:

We are well acquainted with Jane JACOBS, mother of John A JACOBS late private Co. G 6th KY Vol Cav of 1861 and claim it for invalid pension to e are now also well acquainted with said John A JACOBS for at least 5 years before be enlisted in the service of the United States. He was a boy of industrious habit and contributed all he could during the 5 years mentioned towards the support of his father and mother who were them(selves) old and needed all the assistance that he could give them there being no others of his children living with him except the said John A and two small children brother and sister of the said John A and he the said
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John A was the only child at home when they could depend on for a support. He labored at home and from home and the proceeds of his labor issued to the benefit of the family the said John A was a single man and was never married and we have no interest whatever in this matter.
Subscribed and sworn to before me on this 5th day of Nov 1880 by Eliza J DOW and Geo W EARLS and I have no interest whatever in this matter.  W Alash? Clk. asey Co Court
(along side of page)
Pension Claim
No. 240006
of Jane JACOBS mother of Jno A JACOBS
Co G 6th KY Cavalry
Affidavit
Stamped: received by U S Pension Office Nov 11, 1880
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Mother's or Father's Army Pension -- Act of July 14, 1862, and Amendment of June 6, 1865.

Proof of Widowed Mother's or Father's Dependence

The attention of claimants is invited to the following instructions and decisions concerning the pension claims of mothers and fathers of deceased officers and soldiers who have left neither widow nor minor child. 1. That the soldier on account of whose service the claim is presented was the son of the claimant; that he left neither widow nor minor child; and to what extent she or he was dependent upon him for support must be shown by the affidavits of two credible witnesses who are not interested in the result of the applications. In the case of mother's it must also be shown whether the husband of the claimant is living; and if not, the date of his death must be proved. 2. In proof of dependence, it must be shown, as above stated , that he or she actually received their support during a stated period, either in whole or in part, from the deceased soldier, by the production of evidence that a portion of the soldier's pay (by allotment ticket, or otherwise) was regularly transmitted to the claimant; by proof that he constantly paid or contributed towards paying claimant's board, house rent, or other specific and necessary expenses; or by such other equivalent testimony as will clearly establish the fact in question. It is not sufficient to prove that the claimant received occasional presents from the deceased. The amount of the property, and to what extent he or she has other means of support, must also be proved. 3. If the mother has a husband living, the fact is regarded as prima facie evidence that she was not, in any degree, depondent upon her son for support. In such case, before she can be admitted on the pension roll, it must be clearly proved by witnesses havong personal knowledge, that her husband has refused or neglected to provide for her support, (stating for how long a time) on account of physical disability to labor, having no other source of income; or else that, having deserted her, he is beyond the reach of legal compulsion to contribute to her maintenance. If the husband's failure to support her arises from physical disability, its degree and character should be shown by medical testimony. 4. It is the decision of the Commissioner of Pensions that if the mother of a deceased soldier has a husband living who is not proved to be either unable to support her, or in such a situation that she cannot enforce her legal claims uppon him for subsistence, she is not entitled to receive a pensionby reason of the service and death of her son.

Single Affidavit I, L M Drye of lawful age, a resident of the (1) County of Marion, in the State of Kentucky, upon my oath declare that I am, and have been for several years, intimately acquainted with Mrs Jane JACOBS, mother of John A JACOBS, deceased, late a Private in Company G, in the 6th Regiment of (2) Kentucky Cav Vols, commanded by Col HALSEY in the war of 1861, &c. That I was also personally well acquainted with the said deceased in his lifetime. That he died unmarried, leaving no widow, child or children as his heirs surviving. I know that for some time previous to said soldier's death he, at least in part if not wholly, supported said mother. That he sometimes mentioned, in my presence, her dependence for support upon him, and he always considered it his duty to aid and assist her to as great an extent as lay in his power, always having a careful regard for her comfort and welfare. That he constantly and regularly contributed to his mother's support for at least (3) 5 years, dating from about the month of (4) ________, in the year 1860, up to the time of his death, which occurred on or about the 27 day of April, 1865. That (5) affiant further states that he was Capt of said Company and Regiment and knew that the parents of the said soldier were not the possessors of real and personal estate to the amount of two hundred dollars therefore their means of support was inadequate and looked to their son for support to a very great extent and that while said John A JACOBS was a member of my said Regiment he contributed to the support of his aged parents by sending his monthly wages to them and in many cases the money passed through his hands from the soldier to the said parents. That the said Jane JACOBS, mother of the above-named soldier, deceased, is now a widow, and has been such ever since the __(left open)___ day of ____(left open)____, A.D. 18__, at which time
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Page 17

(6)______(left open)_______, her husband, died in the (1) _____(left open)_____ of ______(left open)____, in the Sate of ______(left open)_____ That the said Jane JACOBS does not, lives upon a lot, piece or parcel of ground containing about (7) _____(left open)_____ situated in the (1) ____(left open)____ of ____________ in the State of _____________, and which property si owned by (8) _________ in whose name the title thereto vests, and which, together with the improvements thereon, is of the value of _________ Dollars. That this property is totally inadequate to the support and maintenance of the said Mrs. ____________ That she neither owns nor has in use any other property, real, personal or mixed, from which a revenue can be derived. That she is poor, and has no income, save and except what little money she may be enabled to earn by her own exertions. That she is incapable of earning her own subsistence, by reason of (9) old age & infirmity. I make these statements from personal knowledge derived from intimate acquaintance with the family, and the circumstances by which they are surrounded. i have no interest in this matter whatsoever, simply making this affidavit as an act of justice to the applicant for pension, and nothing further. L M DRYE, Witness Late Capt. Co G 6th KY Cav Sworn to and subscribed before me, this 2nd day of August, in the year 1878, and I bereby certify that the affiant is a respectable and credible person; that I believe affiant's statements are correct and worthy of full faith and credit; and that I have no interest in this matter. Also, that the foregoing affidavit was read to and understood by the affiant before the signing thereof. John Severance, clerk Marion County Court State of Kentucky
(along side of page)
Additional Evidence
Mother's or Father's Application for Army Pension
Case No. _____
Act of July 14, 1862
Mrs, Jane JACOBS and mother of John A JACOBS deceased, Co G, 6th KY Cav Vol.
Proof of Dependence - Single Affidavit
of Capt L M DRYE Co G, 6th KY Cav Vol
filed by Saml Belden, Lebanon, KY.
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Page 18

Father, Mother, or Orphan Brother's Application for Army Pension, Act June 6, 1866.

This Army Pension Declaration must be executed before a Judge or Clerk of a Court or Record, and if before the Judge, the Clerk thereof will certify said Judge's official capacity and signature, and attest the same under the seal of the Court. A Justice of the Peace must not authenticate this paper. If he does, the work is utterly useless, and must be all done over again before a Judge or Clerk of a Court or Record, as above stated.
State of Kentucky}
County of Taylor } On this 1st day of June A.D. 1878 personally appeared before the undersigned, (1)Justice of the House of the (2) Taylor County Court, a Court or Record within and for the County and State aforesaid Jane JACOBS aged 74 years, resident of the (3) County of Marion in the State of Kentucky, who being first duly sworn according to law, doth on her oath make the following declaration, in order to obtain the benefits of the provisions made by the 12th Section of the act of Congress approved June 6, 1866: That she is the mother of (4) John A JACOBS deceased, who was a private in Company G commanded by Captain John DRYE in the 6th Regiment of (5) Kentucky Cav Vol commanded by Col. HALSEY in the war of 1861, and who was (6) lost whiilest in the service aforesaid, on Steamer SULTANA in the State of Tennessee on or about the 27th day of April A.D. 1965 from (7) _______________ incurred in the service aforesaid and whilst in the line of duty (8) & while on Boat SULTANA on Mississippi River near Memphis, Tenn. Boat was blown up & her said son was lost. She further declares that her son upon whom she was wholly or in part dependent for support, having left no widow or minor child under sixteen years of age, surviving, not any other relative nearer of kin than thereof, declarant makes this application for a pension under the above mentioned act, and refers to the evidence filed herewith, and that in the proper department, to establish her claim. Claimant also declares that she has not, in any way, been engaged in, or aided or abetted, the rebellion in the United States; that she is not in the receipt of a pension under the 2d. section of the act of 18th July, 1862, nor any other act of Congress. She appoints Samuel Belden of Lebanon, Kentucky her attorney, with full power of substitutions and revocation in her said behalf, and authorizes him to receive the Pension Certificate when issued. Post Office at Saloma County of Taylor and State of Kentucky. That her domicile or place of abode is (9) Marion County, KY. Jane x JACOBS {Seal} Applicant

Sworn to, subscribed, and acknowledged before me the day and year first above written, and also appeared Alford M JACOBS and Mary A WHEELER residents of the (3) County of Marion in the State of Kentucky, persons whom I certify to be respectable and entitled to credit, and who being by me duly sworn, say that they were present and saw Jane JACOBS (10) sign her (11) name to the foregoing declaration; and they further swear that they have every reason to believe, from the appearance of the applicant and their acquaintance with her, that she is the identical person she represents herself to be, and that they have no interest in the prosecution of this claim. Attest: Cattie M TANDY Witness: Alford M JACOBS Almury? TANDY Witness: Mary A x WHEELER

Sworn to and subscribed before me, this 1st day of June A.D. 1878 and I hereby certify that I have no interest, direct or indirect, in the prosecution of this claim. I further certify that the foregoing declaration and joint affidavit were read over to and understood by the respective parties before they made their several signatures to the same. James E TANDY, JPTC. Court.
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Page 19

Clerk's Certificate

Note - If the Clerk of the Court (Deputy will not answer) takes the declaration and affidavit instead of the Judge, he signs the foregoing certificate, (at bottom of reverse page) and places the seal of the Court thereto, and the following certificate then goes unauthenticated; but if the Judge administers the oaths, he signs the said certificate, and then the Clerk himself authenticates the certificate hereto following: This Certificate should be authenticated by the Clerk himself.

State of Kentucky}
County of Taylor } SS
I, C W Wright Clerk of the Taylor County Court in and for the County and State above named, do hereby certify that Jas E GADY? before whom the foregoing Pension Declaration and joint affidavit were made, and who has thereunto signed his name, was at the time of so doing a Justice of the Peace in Taylor County in and for said County and State above named, duly elected, qualified and sworn that all his official acts as such are entitled to full faith and credit, and that his signature thereto in genuine. Given under my hand and seal of Taylor County Court, at office in Campbellsville this 20th day of June 1878. C W Wright Clerk Clerk of the Taylor County Court

Remarks: - The Second Auditor, in case the Deputy authenticates the Clerk's certificate, requires that the Deputy is duly appointed and authorized by law to sign the Clerk's name and use the seal of the Court, else the authentication by the Deputy is good for nothing - therefore it is better to have the Clerk's own individual authentication at once and thus save the trouble and expense of a general authentication certificate respecting the Deputy.

(along side of page)

Dec O.K.

Application for Army Pension
War of 1861
Act of June 6, 1866

Mrs Jane JACOBS mother of John A JACOBS
Late a Private of Co. G of the 6th Regiment of KY Cav Vols

Declaration not O.K. O'C

Filed by Samuel Belden of Lebanon, KY

(bottom of page)
Instructions
1. "Judge" or "Clerk"
2. Name of the Court
3. "City", "Town", Corporation" or "County" as case may be.
4. Name of the deceased soldier.
5. "Cavalry", "Infantry", or "Artillery" Volunteers of _____ (here give state) naming the troops as indicated according to the corps they belong. If if the regular service, in place of the foregoing add : "United State Infantry", "Cavalry" or "Artillery" as case may be.
6. "Whilst in" or "since discharged from" as the case may be.
7. "Wounds" or "rupture" or "the effects of Typhoid Fever", "Pneumonia", "Measles", "Rheumatism", "Chronic diarrhea", "Dysentery", "Cholera Morbus", "Phthisis", or any other disease, physical disability, or injury, whatever it may be, naming it.
8. If killed in Battle, add: "Being killed in battle at ______ date of his death", or if dyiing of wounds after Battle, instead of the foregoing, say: "Being received in battle or action at ________ on the ____ day of ______ A.D. 18___.
9. "House No. ____ on _____ street, between ________ and ________ streets, in the city of _______ in the County and State aforesaid", or if on the other hand, the applicant resides in the country instead of the city, in place of the foregoing, say: "on the wagon (or rail) road leading from ______ to _______ about _______ miles from __________ the County, State above named.
10. "Sign" or "make".
11. "Name" or "mark" as the case may be.
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Page 20

Declaration for Pension of Dependent Brothers & Sisters

State of Kentucky }
County of Jefferson}

On this 13th day of May, A.D. one thousand eight hundred and ninety, personally appeared before me, Clerk Jeff. Co. Ct. KY, the same being a court of record within and for the countyand State aforesaid, Josephine A WHEELER, a resident of South Park, County of Jefferson, in the State of Kentucky, aged 40 years, who being duly sworn according to law, makes the following declaration in order to obtain the pension provided by Act of Congress for dependent brothers and sisters: That she is the only legal sister of John A JACOBS, who (1) enlisted under the name of John A JACOBS at __x__ on the __x__ day of __x__, A.D. 1862, (2) in Co. G, 6th KY Cavy., in the waro f the rebellion, who died (3) was drowned in the Mississippi River on the 27 day of April, A.D. 1861 and who bore at the time of his death the rank of private in (4) Co G ^th KY Cavy that he left neither widow, minor child, nor (5) no mother or father that the above-named is the only legitimate sister, including those of the half-blood, of the said deceased John A JACOBS surviving, who were under sixteen years of age at the time of his death, and were dependent upon him, of whom (6) John A JACOBS was all her dependent for support.
That the parents were married under the names of (8) ______X______, there being no legal barrier to such marriage; that none of said brothers or sisters have aided or abetted the rebellion; that no prior application has been filed; (9) that she hereby appoints E H Gelston & Co. Wash. D.C. her attorney to prosecute the above claim; that her residence is at No. ___ in ____ street, in the _______ of ________, county of _______, State of _______ and that her post office address is South Park, Jefferson Co., KY. Josephin A WHEELER Signature of Claimant

Personally appeared Joel F MILLS, residing at No. ____ in ____ street, in Casey County KY, and Richard EDWARDS residing at No. ____ in ____ street, in Casey County KY, persons
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Page 21

whom I certify to be respectable and entitled to credit, and who, being duly sworn, say their acquaintance with her that she is the identical person she represents herself to be; and that they have no interest in the prosecution of this claim. Identifying} Joel F MILLS Witnesses} Richard EDWARDS

Sworn to and subscribed before me this 19 day of April, A.D. 1890, and I hereby certify that the contents of the above declaration, &c. were fully made known and explained to the applicant and witnesses before swearing, including the words____(left open)_____ added; and that I have no interest, direct or indirect, in the prosecution of this claim. G A Prewitt, Clerk Casey County Court Official Signature By James Giboney? D.C. Official Character

1. "Was enlisted", "drafted" or otherwise, as the case may be.
2. State company and regiment, if in army; or vessel, &c if in navy.
3. State nature of wounds and all circumstances attending them, or the diseased and manner in which it was incurred; in either case showing the soldier's death to have been the sequence.
4. "In the service aforesaid" or otherwise, as may have been the case.
5. If mother of father survived the soldier and subsequently died, so state, giving date of death; otherwise add, "mother nor father surviving".
6. If any have died state date of death.
7. State names of children and of both parents, also date of birth.
8. Give names of parents and places and dates of marriages.
9. If either soldier or his father or mother have previously applied, so state, giving date and number of application.

Notes. All the blanks in this form should be carefully filled and requirements of the notes strictly observed. An honorable discharge from the service in all cases is necessary. Declarations of claimants, either for original pension or for increase of pension already granted, must be made before a Court of Record, or before some officer thereof having custody of its seal; said officer being full authorized and empowered to administer and certify any oath or affirmation relating to any pension or application therefor. The claimant's identity and loyalty must be proven by two witnesses, certified by the judicial officer to be respectable and credible, who are present and witness the signature of the declarant, and certify to his identity and loyalty under oath or affirmation. Declarations and other papers should be as legible and as clear in statement as possible. Where any evidence is already on file in any Department of the Government, a definite description of and specific reference to it will render it available in any subsequent claim. The post office address(naming street number in all large cities) of the applicant, attorney, and witnesses, should be embodied in or accompany every application, and all eveidence in each claim; and each change of residence of said parties, while communicating with the Pensin Office or the pension agents should be stated. Pensions are, by law, exempted from any liability on account of the obligations of the pensioners, and no lien upon them can be recognized. All facts, testimony of which is required to establish a claim, must be proven by the affidavits of two or more credible witnesses, unless other evidence is specified. The statements of claimants, unless duly corroborated, are not accepted as evidence. Testimony, in support of allegations made in a declaration, may be taken before any officer whose authority and signature are duly certified, and who shall disclaim any interest, direct or indirect, in the prosecution of the claim. Persons desiring to complete claims pending at the decrease of the claimants, must furnish a duly verified certificate of their authority as heirs or legal representatives. With all claims for arrears, increase, or restoration to the rolls, the original pension certificate must be returned, or explanation of its absence must be given under oath. To facilitate the adjudication of claims, all the requisite evidence that is available should be forwarded with the application.

(along side of page)
Brothers and Sisters Calim for Pension
Original
Josephine A WHEELER Applicant, sister of
John A JACOBS Pvt Co. G 6th Regiment
KY Cavy Vols.
Filed by E H Gelston & Co
Washington, D.C.
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Page 22

Father, Mother, or Orphan Brother's Application for Army Pension, Act June 6, 1866.

This Army Pension Declaration must be executed before a Judge of Clerk of a Court of Record, and if before the Judge, the Clerk thereof will certify said Judge's official capacity and signature, and attest the same under the seal of the Court. A Justice of the Peace must not authenticate this paper. If he does, the work is utterly useless, and must be all done over again before a Judge or Clerk of a Court of Record, as above stated.

State of Kentucky}
County of Taylor }

On this 4th day of May A.D. 1880 personally appeared before the undersigned, (1) Clerk of the (2) Marion Court, a Court of Record within and for the County and State aforesaid, Jane JACOBS aged 74 years, resident of the (3) County of Marion in the State of Kentucky, who, being duly sworn according to law, doth on her oath make the following declaration, in order to obtain the benefits of the provisions made by the 12th Section of the act of Congress approved June 6, 1866: That she is the mother of (4) John A JACOBS deceased, who was a private in Company G commanded by Captain DRYE in the 6th Regiment of (5) Kentucky Vol Cavalry commanded by Col HAILSEY in the war of 1861, and who (6) whilst in the service the service aforesaid, at _______ in the State of ________ on or about the 29th day of April A.D. 1865 from (7) _________ incurred in the service aforesaid and whilst in the line of his duty (8) lost on Boat SULTANA on Miss. River near Memphis, Tenn Boat blown up. She further declares that her son upon whom she was wholly or in part dependent for support, having left no widow or minor child under sixteen years of age, nor any _________ declarant makes this application for a pension under the above mentioned act, and refers to the evidence filed herewith, and that in the proper department, to establish her claim she also declares that she has not, in any way, been engaged in, or aided or abetted, the rebellion of the United States; that she is not in the receipt of a pension under 2d section of the act of 18th July, 1862, nor any other act of Congress. She appoints Belden & McChord of Lebanon, KY her attorney, with full power of substitution and revocation in her behalf, and authorizes _____ to receive the Pension Certificate when issued. Post Office is at New Market County of Marion and State of Kentucky. That her domicile or place of abode is (9) near New Market, KY Jane JACOBS {seal} Applicant

Sworn to, subscribed, and acknowledged before me the day and year first above written, and also personally appeared Finley? SHUCK and Geo R KELLY residents of the (3) County of Marion in the State of Kentucky, persons whom I certify to be respectable and entitled to credit, and who, being by me duly sworn, say that they were present and saw Jane JACOBS (10) sign her (11) name to the foregoing declaration; and they further swear that they have every reason to believe, from the appearance of the applicant and their acquaintance with her that she is the identical person she represents herself to be, and that they have no interest in the prosecution of this claim. Finley SHUCK Geo R KELLY
Sworn to and subscribed before me, this 4th day of May A.D. 1880, and I hereby certify that I ahve no interest, direct or indirect, in the prosecution of this claim. I further certify that the foregoing declaration and joint affidavit were read over to and understood by the respective parties before they made their several signatures to the same. John Severance Clk. Marion County Court.
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Page 23

Clerk's Certificate

Note - If the Clerk of the Court (Deputy will not answer) takes the declaration and affidavit instead of the Judge, he signs the foregoing certificate, (at bottom of reverse page) and places the seal of the Court thereto, and the following certificate then goes unauthenticated; but if the Judge administers the oaths, he signs the said certificate, and then the Clerk himself authenticates the certificate hereto following: This Certificate should be authenticated by the Clerk himself.

State of Kentucky}
County of Marion } SS

I, John Severance Clerk of the Marion County Court in and for the County and State above named, do hereby certify that ________ before whom the foregoing Pension Declaration and joint affidavit were made, and who has thereunto signed his name, was at the time of so doing a Judge of the ________ Court in and for said County and State above named, duly elected, qualified and sworn that all his official acts as such are entitled to full faith and credit, and that his signature thereto in genuine. Given under my hand and seal of _________ Court, at office in ________ this ___ day of _____, 186__. Clerk of the ________ Court.
Remarks - The Second Auditor, in case the Deputy authenticates the Clerk's certificate, requires evidence that the Deputy is duly appoointed and authorized by law to sign the Clerk's name and use of the seal of the Court, else the authentication by the Deputy is good for nothing - therefore it is better to have the Clerk's own individual authentication at once and thus save the trouble and expense of a general authentication certificate respecting the Deputy.

Forwarded by___________

Stamped: Department of the Interior Pension Office May 10, 1880

(bottom of page)
Instructions
1. "Judge" or "Clerk"
2. Name of the Court
3. "City", "Town", Corporation" or "County" as case may be.
4. Name of the deceased soldier.
5. "Cavalry", "Infantry", or "Artillery" Volunteers of _____ (here give state) naming the troops as indicated according to the corps they belong. If if the regular service, in place of the foregoing add : "United State Infantry", "Cavalry" or "Artillery" as case may be.
6. "Whilst in" or "since discharged from" as the case may be.
7. "Wounds" or "rupture" or "the effects of Typhoid Fever", "Pneumonia", "Measles", "Rheumatism", "Chronic diarrhea", "Dysentery", "Cholera Morbus", "Phthisis", or any other disease, physical disability, or injury, whatever it may be, naming it.
8. If killed in Battle, add: "Being killed in battle at ______ date of his death", or if dyiing of wounds after Battle, instead of the foregoing, say: "Being received in battle or action at ________ on the ____ day of ______ A.D. 18___.
9. "House No. ____ on _____ street, between ________ and ________ streets, in the city of _______ in the County and State aforesaid", or if on the other hand, the applicant resides in the country instead of the city, in place of the foregoing, say: "on the wagon (or rail) road leading from ______ to _______ about _______ miles from __________ the County, State above named.
10. "Sign" or "make".
11. "Name" or "mark" as the case may be.

Taylor County Military Records