State of Ohio Wood County ss:
On this 26 day of Jan. 1922, personally appeared before a Notary Public within and for the county and state aforesaid, Samuel Shroyer aged 84 years late a member of the A. 100 Reg. Ohio Vols, a resident of the county and state aforesaid, who being duly sworn according to law, declares that he is a pensioner of the United States under certificate numbered 203.052. That he believes himself entitled to an increase of pension on account of disabilities that require the aid and assistance of a nurse most of the time, that he is almost helpless, and that his disabilities are of a permanent character. His post office address is Weston, Wood Co. Ohio.
Samuel Shroyer
His mark
Also personally appeared Ida M. Watson and Ocea J. Neifer, residing at Weston, Ohio, whom I certify to be respectable and entitled to credit and who, being duly sworn say they were present and saw the claimant make his mark to the foregoing declaration; that they know him to be the identical person he represents himself to be and that they have no interest direct or indirect in the prosecution of this claim.
Ida M. Watson
Ocea J. Neifer
Sworn to and subscribed before me this 26 day of Jan. 1922; 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; and that I have no interest direct of indirect in the prosecution of this claim
Solon Davis
Notary Public
(Written on side: “Certificate N.203.052
Claim for Increase Pension
Claimant
Samuel Shroyer
C. A. 100 Ohio Vol. Inf
Weston, Ohio”)
(Stamped on bottom “Record Division FEB 23 1922” and “Record Division FEB 1 1922” and written between stamps “Filed by Claimant Weston, Ohio”)
From Civil War pension file of Samuel Shroyer