Request for Compensation,
General Affadavit of Harriet Tubman Relating to Her Claim for a Pension, 1898 (facsimile)

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[The Following Form is Crossed Out]

State of ___________________, Country of ___________________, ss:
In the matter of _________________________________________________
ON THIS ________ day of_____________________, A. D. 18___, personally
appeared before me____________________________ in and for the afore-
said County, duly authorized to administer oaths_______________________
aged__________years, a resident of______________________, in the County
of___________________, and State of__________________________
whose Post-office address is______________________________________
_____________________, aged______years, a resident of______________
______________________, in the County of________________________
and State of____________________, whose Post-office address is_________
well known to be reputable and entitled to credit, and who, being duly sworn, declared in relation to aforesaid case as follows:

(NOTE.-Affiants should state how they gain a knowledge of the facts to which they testify.)

My claim against the U.S. is for three years services. As Nurse and cook in hospitals, and as commander of Several Men (Eight or Nine) as scouts during the late war of the Rebellion, under directions and orders of Edwin M. Stanton Secretary of War, and of several Generals.

I claim for my services above named the sum of Eighteen hundred dollars

The annexed copies have recently been read over to me and are true to the best of my knowledge information and belief.

I____ further declare that I have interest in said case and am___ not concerned in its prosecution. and allowance.

Onim McCarty
M. Elsie McCarty
(If Affiants sign by mark, two witnesses who write sign here.)
Harriet X Davis
Sate [?] Harriet Tubman
(Signature of Affiants.)


Note: Question marks represent illegible text.