Form No. 3 Application of Widow I, ADALINE C. ELY, do hereby apply for aid under the act of the General Assembly of Virginia, approved April 2, 1908, entitled an act to aid the citizens of Virginia who were diabled by wounds recieved during the war between the states while serving as soldiers, sailors, or marines of Virginia, and such as served during the said war as soldiers, sailor, and marines of Virginia, who lost their lives in said service, or whose death resulted from wounds recieved or disease contracted in said service, and providing penalties for violating the provisions of this act, and I do solemnly swear that I am a citizen of the State of Virginia resident at- PENNINGTON GAP-, in the county of- LEE- in the said State, and that I have been an actual resident of the said State for two years, and of the said city (or county)for one year next preceding the date of this application, and that I am the widow of -THOMAS J. ELY- who was a soldier( sailor or marine) in the service of the State of Virginia, in the war between the States and who was a member of( here state specifically the command and branch of service to which the husband of the applicant belonged and if possible, the names of his immediate superior officers)-CO. A. VA (unreadable) Company Offs. (unreadable)_______________________________? and who while in the discharge of his duty in the military or naval service of the State of Virginia or of the Confederate States during the said war, lost his life( if the husband of such wife was killed or died during the war as a result of wounds recieved, state the facts of the cause as near as possible, giving the date of the husbands death-__ -RHEUMATISM DUE TO EXPOSURE WAS CONTRACTED-. (If the husband died after the war, strike out all relating to his death during the war, and then proceed as follows:)and who has since the war died( here state specifically the name of the death of the husband of the applicant and the date thereof)ROBERT R. Stapleton (unreadable) and that to the best of my knowledge my husband was loyal and true to his duty, and never at any time deserted his command or voluntarily abandoned his post of duty, and that I was never divorcedfom my said husband, and that I never voluntarily abandoned him during his life, but remained his true, faithful and lawful wife up to the date of his death, and that I am a widow at the date of making this application, and that I am entitled to recieve, under the said act the sum of Twenty Five dollars annualy. And I do futher swear that I do not hold any position or office either national, State, city or county which pays me a salary or fee Two hundred per annum; nor have I an income recieve from any other employment or other source whatsoever which amounts to Two Hundred dollars per annum; nor do I recieve from any source whatever money or other means of support amounting in value of the sum of Two Hundred dollars per annum; nor do i own by my own right, nor does hold in trust for my benefit, or use estate or property either real, personal or mixed, either in fee or for life, of the assumed value of Seven Hundred and Fifty dollars; nor do I recieve any aid or pension from any other State, or from the United States, or from any other source, and that I am without means of support, direct or indirect; and I do further swear that the answers given to the following questions are true: 1. What is your name? Ans- ADALINE C. ELY 2. What is your age? Ans -(UNREADABLE)(68?) 3. Where were you born? Ans- (UNREADABLE) 4. How long have you resided in Virginia? Ans- (UNREADABLE) 5. How long have you resided in the city or county of your (actual) residence? Ans- 68 years 6. Where do you reside? Ans-(UNREADABLE) County of LEE, Virginia 7. With whom do you reside? Ans-(UNREADABLE) 8. What is your husbands full name? Ans-THOMAS JAMES ELY 9. When, where, and by whom were you married? Ans-When? FEB. 1868 BY REV. CROFT WHERE? (UNREADABLE) LEE CO.,VA 10. When and where did your husband die? Ans-MAY 4, 1908 WHERE? (UNREADABLE) 11. What was the cause of his death? Ans- CIROSIS OF THE LIVER 12. Give the name and address of physician who attended your husband at the time of his death. Ans-(UNREADABLE) 13. Have you married since the death of your husband? If yes, give full particulars. Ans- NO 14. In what branch of the army did your husband serve? Ans- 3rd KENTUCKY 15. Who were his immediate superior officers? Colonel- M C ELY Captain- CLEVELAND BAYES 16. Give the names and addresses of two comrades who served in the same command with your husband during the war. J F W SADLER JONESVILLE,VA FRANK(UNREADABLE) (UNREADABLE) 17. Give the names and addresses of two persons who are familiar with the circumstances of your husbands serve and death. J F W SADLER JONESSVILLE,VA (UNREADABLE) 18. What maintenence do you recieve, and what income have you from all sources? Ans- (UNREADABLE) 19. How much property do you own? Ans- Real Estate-$41.-- Pwersonal Property- $14.2- 20. Was your husband on the pension roll of Virginia? Ans-NO 21. Have you applied for a pension in Virginia before? Ans- NO 22. Is there a camp of Confederate Veterans in your city or county? Ans-(UNREADABLE) 23. Give here any other information you may pocess relating to the service of your husband or the cause of his death which will support the justice of your claim. Ans-(UNREADABLE) A signiture made by X mark is not valid unless attested by a witness. her Adaline X C. Ely mark I, D. H. SADLER , a ___ of this __ in and for the County of LEE, in the State of Virginia, do certify that the applicant whose name is signed to the foregoing application, personally appeared before me in my county, aforesaid having the aforesaid application read to her and fully explained, as well as the statements and answers therein made, the said applicant made oath before me that the said statements and answers are true. Given under my hand this 29th day of Feb, 1908 D H SADLER C. C. Ferh F. T. Brown