I, Adam Coffman, a native fo the State of Virginia, and now a citizen of Virginia, resident at
Lantz Mill in the county (or city) of Shenandoah in said State of Virginia, and who was a soldier
from the state of ________, in the war between the United States and the Confederate States, do
hereby apply for aid under the act of the General Assembly entitled "An act to give aid to
soldiers, sailors, and marines of Virginia, maimed or disabled in the war between the States,
and to the widows of Virginia soldiers, sailors and marines who lost their lives in said war in
the military service." And I do solemnly swear that, while in the discharge of my duty in the
service of the Confederate States, as a member of Company C 7th Virginia Calvary on or about the
21st day of January 1865, I was wounded in the battle of Picket scouts drove us off and
that from the effects of such would I was disabled, as follows: Was wounded between the hip
& knee and that by reason of such wound and disability I am now entitled to receive, under
said Act, the sum of _____________ dollars annually. I further swear that I do not hold any
national, State, or county office which pays me in salary or fees over three hundred dollars
per annum; nor have I an income from any other source which amounts to three hundred dollars;
nor do I own in my own right, nor does my wife own, property of the accessed value of more than
one thousand dollars; nor do I receive aid or a pension from any other State of from the
United States; and that I am not an inmate of any soldiers' home.
I do further swear that the answers given to the following questions are true:
1st. What is applicant's age? Ans. 51
2d. In what battle or combat, or under what circumstances was the applicant wounded? Ans.
was wounded on Stony Creek while on picket driven back by yankee scouts
3d. What was the precise nature of the wound received? Ans. was wounded between the hip
& knee
4th. What limb, if any, did the applicant lose by reason of said wound? What eye, if any,
did he lose? Ans. None
5th. If no limb or eye was so lost, what is the precise nature of the disability occasioned
thereby? Ans. I am totally disabled from manual labor
6th. Is it total? Yes
(a) Is it partial? and, if so, to what extent does it disable him from manual labor? Ans.
I am totally disabled from manual labor.
Given under my hand this 13th day of August 1888.
