Declaration for an Invalid Pension
This invalid Pension Declaration must be executed before a Judge or Clerk of a Court of Record, and if before the Judge, the Clerk thereof will certify said Judge's official capacity and signature, and attest the same under the seal of the Court.  A Justice of the Peace must not authenticate this paper. If he does, the work is utterly useless and must be all done over again before a Judge or Clerk of a Court of Record, as above stated.
State of Pennsylvania
County of Allegheny  

On this 6th day of May A.D. one thousand eight hundred sixy nine, personally appeared before me (1) Prothanery (?) of the Court of Common Please, a Court of Record within and for the County and State aforesaid, Bernard Pichel, aged 34 years, a resident of the City of Pittsburgh, in the State of Pennsylvania, who, being duly sworn according to law, declares that he is the identical Bernard Pichel who Private Corporal in the service of the United States at Pittsburgh in the State of Pennsylvania, on or about the 23rd day of September in the year 1861 as a private in Company G commanded by John Hann in the 74 Regiment of Pennsylvania commanded by Col. Shimelfen (?) in the war of 1861 and was honorably discharged at Hospital Washington in District of Columbia on or about the 4 day of April in the year one thousand eight hundred and sixty three; that wile in the services aforesaid, and in the line of his duty, he contracted disease of the lung known by the name of Bronchitis connection with the chronic rheumatism, both diseases disables the applicant from being able to labor at his trade and has constantly to the doctoring for said diseases and is there by put to great expense and not able to earn, but able by reason of said disablities.

That since leaving the said service, this applicant resided in the City of Pittsburgh, in the State of Pennsylvania, and his occupation has been cigar maker.

He makes this declaration for the purpose of being placed on the Invalid Pension Roll of the United States by reason of the disablities above stated, and revoking and countermending all other authority that may have been given, he hereby constitutes and appoints, with full power of substitution and revocation, A. C. Powers of Pittsburgh, his true and lawful attorney, to prosecute his claim, and obtain the Pension Certificate that may be issued. That his Post Office is at Pittsburgh Diamond St, County of Allegheny, State of Pa.  That his domicile or place of abode is Diamond Street No. 29.
*Transcribed from original document
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