Served with the 50th Virginia Regt. Infantry Co. "H"

               Statement of Soldier, Sailor or Marine
   Pensioner under act of March 7, 1900, to be filed before Circuit or
          Corporate Court or the Judge thereof in vacation.

I, HENRY STAPLETON, of the county of WISE, in the state of VIRGINIA,
do solemnly swear that I am the indentical person named in the original
application dated on the 25TH day of JUNE, 19__, and who filed the said
application for aid under the provisions of an act of the General Assem-
bly approved March 7, 1900, for aid as a soldier( sailor or marine)
of Virginia, in the service of the said state, or of the Confederate
States during the war between the states, and that I am now an actual
resident of the county of WISE, in the said state, and that i do not
hold any national, state, city, or county office which pays me in
salary or fees one hundred and fifty dollars per annum; nor have I
income from any other employment or other source which amounts to one
hundred and fifty dollars per annum; nor do I recieve from any source
whatever money or other means of support amounting in value to the sum
of one hundred and fifty dollars per annum; nor do I own in my own right,
nor does anyone hold in trust for my benefit, or use, nor does my wife
own, nor does anyone hold in trust for the benefit of my wife, either
real, personal, or mixed property or estate, either in fee or for life,
of the assumed value of five hundred dollars; nor do I recieve said
aid or pension from any other state, or from the United states, or from
any other source, and that I am not an inmate of the Soldier's Home
or public institution. And I do further swear that I am disabled as 
follows: RHEUMATISM WITH LEFT EYE NEARLY OUT and that my disability
came from OLD AGE and that I am now 67 years of age, and that the 
statements contained in my original applications above referred to are
true, and that during the said war I was loyal and true to my duty
as a soldier( sailor or marine) of Virginia, or of the Confederate
States, and never at any time deserted my command, or voluntarily
abandoned my post of duty in the said service.
                                                      His
                                               HENRY  X  STAPLETON  
                                                      Mark

Subscribed and sworn before me a DEPUTY CLERK, in and for
the county of WISE, in the state of Virginia, this 20th day of 
August, 1902.                                A. D. DORTON DC

                         JURAT OF WITNESSES

We, LEVI PERRY and H. C. JONES, of the county of WISE, in the
state of Virginia, do solemnly swear that we are personally aquainted
with HENRY STAPLETON, whose name is signed to the annexed (jurst?)
and that the said HENRY STAPLETON is still living, and that we verily
believe the statements contained in the annexed affidavid to be true.

                                                LEVI PRERRY  
                                                H. C. JONES

Subscribed and sworn to before me a DEPUTY CLERK, in and for
the county of WISE, and I do certify that the said LEVI PERRY
and H. C. JONES, whose names are signed to the annexed (jurst?)
are persons of well-known reputation for truth, honesty, and 
integrity, and residing in the said COUNTY OF WISE
                                                A. D. DORTON DC

            CERTIFICATION OF THE COMMISSIONER OF THE REVENUE

I, W. D. McNIEL, Commissioner of the Revenue, in the COUNTY of WISE,
in the state of Virginia, do certify that HENRY STAPLETON, or his
wifw, or his trustee for his wife, whose name is signed to the annexed
statement, and who made application for aid under the act of the
General Assembly of Virginia approved March 7, 1900, is charged on 
the land and personal property books of the said COUNTY with estate
real, personal, and mixed of the assumed value of NO dollars.
Given under my hand this 9th day of August, 1902.

                                                   W. D. McNIEL

            CERTIFICATION OF PHYSICIAN AS TO SOLDIERS,ETC.

I, H. M. MILES, a practicing physician in the COUNTY of WISE 
in the state of Virginia, do certify that I am personally aquainted 
with HENRY STAPLETON, whose name is signed to the foregoing 
statement, and who made application for aid under the act of the
General Assembly approved March 7, 1900, and that from a personal
examination of the said HENRY STAPLETON as to the disability set
forth in his application and the cause thereof, I am clearly of
the opinion that he is disabled by reason of( here state specifically
the nature of the disability and the cause thereof, and whether it is
total or partial, and whether the applicant is deprived of abilty to
pursue his usual and ordinary occupation for his livelihood, or any
other occupation within his capacity)HAD HAD AN ACCIDENT WHICH BROKE
HIS COLLAR BONE AND HIS SHOULDER AND PARTIALY PARALIZED HIS RIGHT
ARM AND HAND. HE ALSO HAS __? CATARACT. PARTIALLY DISABLED.
and I verily belive his disability is wholly due to the causes as-
signed in the application, and that he is entitled to aid under the
provisions of the act of the General Assembly of Virginia approved 
March 7, 1900.

Given under my hand, this 20th day of August, 1902
                                                   H. M. MILES

VIRGINIA:
County (city) of WISE, to-wit:
I, W. C. KILGORE, Clerk of the Circuit (Corporation) Court
of the county (city) of WISE, do certify that the (Judge of
the) said court has directed me to certify to the Auditor of
Public Accounts that HENRY STAPLETON a pensioner under the 
act of March 7, 1900, is entitled to recieve annually from
the State of Virginia the sum of FIFTEEN dollars.

Given under my hand this 26th day of August, 1902   
                                                  W. C. KILGORE