Anna Roberts's Pension Claim Question Blank

Anna Roberts, the widow of the Civil War veteran Samuel L. Roberts filled out this questionnaire to be able to receive pension after his death. She hired D. P. Blish, a pension claim agent to do the paperwork. Such documents are invaluable to the family, social, and economic history for the accurate record of names, birthdates, places of residence, information on the application procedure, and amount of pensions.

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Question Blank for the Widow or Children of a Deceased Soldier, to be filled up
and returned to

D.P. Blish, Pension Claim Agent
Omaha, Nebraska

Full name of widow Anna Malona Roberts age 63 years
Post Office address, Town Alma County Harlan State Neb
Full Name of Soldier Samuel Leonidas Roberts
Rank Sergeant, Co. G Reg't Iowa 15 Vol
Date of Enlistment Nov 24 1861; Date of discharge July 24 1865
Re-enlisted Mar 1, 1864
Where did he enlist, Town Keakuk State Iowa
Date of his death July 23 1916 Place of his death Alma Neb
How much did he draw per month 25 Give numbers of pension certificate 174732
Name of widow before her marriage to soldier Anna Malona McHathery
Date of Marriage Febr 1 1872; By whom married R. S. Symington
Where married, Town Pleasant Hill State Mo
Had widow been previously married, No Had soldier been previously married No
Has the widow remarried since the soldier's death No Give name and date
of Birth of each child of the soldier under sixteen years of age at the date of his death:

None