State of Pennsylvania
County of Allegheny

On this 14th day of March A. D. 1865 personally appeared before me Clerk of the Orphan's Court within and for the County and State aforesaid JANE CLARK a resident of Manchester County and State aforesaid aged Forty-three years, who being first duly sworn according to law, doth on her oath make the following declaration, in order to obtain the benefits of the provisions made by the Act of Congress approved July 14th 1862; That she is the widow of NATHANIEL CLARK deceased and mother of HENRY W. CLARK deceased who was a 1st Lieutenant in Company "N" Commanded by Captain Wilson in the 1st Regiment of Va Mounted Vols. in the War of 1861, who died unmarried without child or children and left surviving him no father on or about the 7th day of July A. D. 1863 at or near a place called GETTYSBURG in the state of Pennsylvania from the effects of a wound received in the battle of Gettysburg while in the service aforesaid and in the line of his duty. She also declares that she has not in any way been engaged in or aided or abetted the rebellion in the United States; that she is not in receipt of a pension under the 2nd Section of the Act above mentioned, or under other Acts nor has she again married since the death of her son the said HENRY W. CLARK.

Jane Clark

Also personally appeared William McClellin and H. C. Mackrill(?) residents of the County and State aforesaid persons whom I certify to be respectable and entitled to credit, and who being duly sworn say that they were present and saw JANE CLARK sign her name to the foregoing declaration and they further swear that they have every reason to believe from the appearance of the applicant and their acquaintances with her that she is the identical person she represents herself to be.

W. McClellnd
H. C. Mackrill(?)

Given to and subscribed before me this 12th day of March A. D. 1865, and hereby certify that I have no interest direct or indirect in the prosecution of this claim.

W. A. Herron, Clk.

Statement of Jos. H. Wilson
Monongahela City, Pa.
March 16th 65

     This is to certify that I commanded Company "N" of the 1st Virginia Vol. Cav of which H. W. CLARK was a 2d Lieut, that he was wounded in a charge made by the Regt on a Reble wagon train near Monterey Springs on the night of the 4th July 1863, from the effects of which he died on the morning of the 6th.

Your Obedt Servt
Jos. H. Wilson

Sworn and subscribed unto before me a Notary Public this 16th day of March 1865.

S. P. Keller
N. P.

Adjutant General's Office,
Washington, D.C.,
August 1, 1865

Sir:
     I have the honor to acknowledge the receipt from your Office of application for Pension No. 91.073, and to return it herewith, with such information as is furnished by the files of this Office.
     It appears from the Rolls on file in this Office, that HENRY M. CLARK was mustered into service as a 2nd Lt. from the 1st day of January 1863, per S.O. No 356- Ex 14 - Dated A.G.O. October 30th 1864, in Company "N", 1st Regiment of W.Va. Cavy Volunteers; to serve Not Stated. On the Muster out Roll of Co. "N" (now "I") of that Regiment, dated July 8th 1865, he is reported "2nd Lt. - Died July 5/63 at Monterey Md from wounds recd in action July 4/63." No evidence on file of his being Promoted to - or mustered out as a 1st Lieut."

I am, Sir, very respectfully
Your obedient servand
S-- Breck
Assistant Adjutant General

(T0:)Commissioner of Pensions,
Washington, D.C.
Memoranda

Affidavit of Mother
District of Columbia
Washington County

     On this 27th day of July 1865 personally appeared MRS. MARGARET JONES, a resident of Washington, D.C. and SAMUEL CALDWELL of same place, persons whom I certify to be entitled to credit, who being duly sworn say that they are well acquainted with MRS. JANE CLARK and have been so acquainted with her for at least twenty years past; that her husband, NATHAN M. CLARK, died some nine years since; that she had only one child, HENRY W. CLARK, who died in the service of the U. States July 7, 1863. That the aforesaid JANE CLARK depended wholly upon her said deceased son for support; that she has no property upon which she can depend for support; that she received the greatest portion of her said deceased sons pay while he was in the U.S. service and that they have no interest in the said JANE CLARK'S claim for a pension.

Margaret Jones
Samuel Caldwell

Sworn to and subscribed before me this 27th day of July, 1865, and I have no interest in Mrs. Clark's claim for a Pension.

M. P. Barry, Deputy Clk

Pensioner Dropped

U. S. Pension Agency,
Washington, D.C.
July 8, 1893

Commissioner of Pensions.

Sir:
     I hereby report that the name of JANE CLARK, who was a pensioner on the rolls of this Agency, under Certificate No. 52905, and who was last paid at $15, to March 4, 1893, has been dropped becaue of death May 15/'93.

Very respectfully,
S. L. Ninson(?)
Pension Agent