Declaration for Pension (21 Jul 1921)

On 31 May 1921, Alfred Brunson Kephart suffered a paralytic stroke. His wife, Mary, filed the Declaration for Pension seen below.


Declaration for Pension (21 Jul 1921). Image courtesy of Verla Williams.

STATE OF Minnesota, COUNTY OF Jackson, ss:

On this 21st day of July, A. D. 1921, personally appeared before me, a Notary Public, within and for the county and State aforesaid, Mary Kephart, wife of Alfred B. Kephart, who being duly sworn according to law, declares ["said Alfred B. Kephart" added] that he is 79 years of age, and a resident of Lakefield, county of Jackson, State of Minnesota; and that he is the identical person who was ENROLLED at Cottage Hill, Iowa, under the name of Alfred B. Kephart on the 22nd day of August, 1862, as a Private in Company H - 21st Regt. Iowa Vol. Inf. in the service of the United States, in the Civil War, and was HONORABLY DISCHARGED at Baton Rouge, La., on the 15th day of July, 1865. That he also served ____.

That his personal description at enlistment was as follows: Height, ___ inches; complexion, ____ color of eyes, ____; color of hair, ____; that his occupation was ____; that he was born ____, 18__, at _____. Have no data available, and his condition is such that no information can be had from him.

That he requires the regular personal aid and attendance of another person on account of the following disabilities: Had paralytic stroke, and left paralyzed. Can move left hand a little, but can't walk, or talk, help himself in any way. Can understand but little of what is said to him. Has been in this condition since the stroke on May 31, 1921. He is confined to his bed entirely, except when we set him up in a reclinging wheelchair for short periods.

That since leaving the service he has resided at Lakefield, Jackson County, Minnesota, and his occupation has been farming until he retired when couldn't work any more.

That he has ___ applied for pension under Original No. ___. That he is ___ a pensioner under ["Reissue" added] Certificate No. 879.556. That he makes this declaration for the purpose of being placed on the pension roll of the United States under the provisions of the act of May 1, 1920.

(1) H. H. Sontag (Signature of first witness)
Lakefield, Minn.
(2) O. Thoreson (Signature of second witness)
Lakefield, Minn.

Mary Kephart (Claimant's signature in full)
Lakefield, Minnesota

SUBSCRIBED and sworn to before me this 21st day of July, A. D. 1921, and I hereby certify that the contents of the above declaration were fully made known and explained to the applicant before swearing, including the words "on opposite page" erased, and the words "on opposite page", added; and that I have no interest, direct or indirect, in the prosecution of this claim.

O. Thoreson (Signature)
Notary Public, Jackson Co., Minn.
My commission expires Jan. 15, 192 [illegible]
Lakefield, Minnesota