I, Henry B. Cook, a native of the State ["State" crossed out] of Germany, 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 Virginia, in the war between the United States and the Confederate States, do hereby apply for aid under the act of the General Assembly intitled "An act to give aid to soldiers, sailors, and marines of Virginia, maimed or disabled in the war between the States, and 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 7^th Va. Cavalry I contracted rheumatism from the "effects" of which I am now partiallly disabled. Am disabled as much as I would be should I have lost an arm or leg and that by reason of such wound and disability I am now entitled to receive, under said Act, the sum of fifteen 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 assessed value of more than one thousand dollars; nor do I receive aid or a pension from any other State or from the United States; and that I am not an inmate of any soldier's home.

I do further swear that the answers given to the following questions are true:

1st. What is applicant's age? Ans. 60

2d. In what battle or combat, or under what circumstances was the applicant wounded? Ans.            

3d. What was the precise nature of the wound received? Ans.            

4th. What limb, if any, did the applicant lose by reason of said wound? What eye, if any, did he lose? Ans.           

5th. If no limb or eye was so lost, what is the precise nature of the disability occasioned thereby? Ans. Rheumatism contracted during service

6th. Is it total? No

(a) Is it partial? and, if so, to what extent does it disable him from manual labor? Ans. Partial, almost entirely disabled

Given under my hand this 7^th day of April 1894.

I, E.D. Newman, Judge of the County Court for the County of Shenandoah, do certify that Henry B. Cook, whose name is signed to the foregoing application personally appeared before me in open court, and, having the said application read and fully explained to him, as well as the statements and answers therein made, he, the said Henry B. Cook made oath before me that the said statements and answers are true.

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