cooper 3

DISABILITY AFFIDAVIT.

No. 749272

Claim of

David G. Cooper

Co. “E”, 4th Regt

Tenn Cav Vol

For

?????? Inv Pension

Filed By Wm. F. Duncan Chutata, Tenn.

DISABILITY AFFIDAVIT.

State of Tennessee}

County of Bradley,}SS:

In the matter of the Original INVALID Pension Claim No. 749272 of David G Cooper .ON THIS 25th day of July A.D. 1890 personally came before me, a Clerk ?????? in and for the aforesaid County, duly authorized to administer oaths, David G. Cooper aged 46 years, a resident of Cleveland in the County of Bradley and State of Tennessee, well known to me to be reputable and entitled to credit, and who being duly sworn declare in relation to the aforesaid case as follows: My Post Office Address is Cleveland Tenn

For 15 years immediately preceding my enlistment into the service of the United States on the _________ day of ________, 196_, I resided in the following named places: near Cleveland Tennessee

Ever since this dern Rebellion and my occupation was that of a Farmer

Since my discharge from said service on the 12 day of July, 1865, I have resided in Bradley County Tennessee and my occupation has been that of a Farmer

I further state that the disability for which I claim pension arises from ____________ which was contracted _______________________________

From my said discharge to the present time, I have received the following medical treatment for said disease 1st by John Brown MD Cleveland Tenn now Dead. Samuel Day Jr. now dead. and John Sugard MD Cleveland Bradley County Tenn

Since the origin of the disability for which pension is claimed, I have suffered with the following acute diseases:_____________________________________

for which I was treated by Dr.________________________________

And during all of the said time my physical condition and ability to perform manual labor has been as follows: That I have been unable to do a full days labor in consequence the said disabillities since any discharge from the army

I further state that the entire service rendered me by is as follows: Co. E 4th Regt Tenn Cav. and that I have not served in the Army or Navy either prior or subsequent thereto.

W F Duncan D G Cooper

Witness Claimant’s Signature

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