Application of Soldier, Sailor, or Marine for Disability
by Reason of Disease or the Infirmities of Age

Submitted by Patricia H. London 13 January 1999; trishahen@earthlink.net

FORM NO.2
I, John B. Gold do hereby apply for aid under the act of the General Assembly of Virginia, approved April 2,1903, entitled and act to aid the citizens of Virginia who were disabled by wounds received during the war between the states while serving as soldiers, sailors, or marines of Virginia, and as such served as soldiers, sailors, or marines of Virginia, who are now disabled by disease contracted during the war, or by the infirmities of age, and the widows of soldiers, sailors, or marines of Virginia who lost their lives in said service, or whose death resulted from wounds received or disease contracted in said service, and providing penalties for violating the provisions of this act, and I do solemnly swear that I am a citizen of the State of Virginia, resident at Clarksville in the County of Mecklenberg in the said State, and that I have been an actual resident of the Said State for two years, and of the said city (or county) for one year next preceding the date of this application and that I was a soldier (or sailor or marine) of the State of Virginia in the war between the United States and the Confederate States as a member of (here state specifically the command and branch of service to which the applicant belonged and the names of his immediate superior officers). Co "G" 14th Virginia regiment Armistead's Brigade and that I am now disabled by disease and the infirmities of age. I am seventy years (of age), and suffer a great deal from rheumatism in arms and legs and that from the effects of such disease I am now permanently disabled from following my usual and ordinary occupation or any other occupation for a livelihood. I am disabled by reason of rheumatism in my arms and legs. And that during the said war I was loyal and true to my duty, and never at any time deserted my command or violated or abandoned my post of duty for the said service, and that by reason of such disability I am now entitled to receive under the said act the sum of Fifteen dollars annually. And I do further swear 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 an income form any other employment or any source whatever which amounts to 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 any on hold in trust for my wife, estate or property, either real personal or mixed, either in fee or for life, of the assessed value of five hundred dollars; nor do I receive any aid or pension form any other State, or from the United States, or form any other source, and that I am not an inmate of any soldier's home, or of any other public institution; and I do further swear that the answers given to the following questions are true: 1. What is your age? 70 years old 2. Where were you born? Mecklenberg County 3. How long have you resided in Virginia? Nearly all my life, in Mecklenberg for the last 15 years. 4. How long have you resided in the city or county of your present residence? For the last 15 years 5. What is your usual and ordinary occupation for earning a livelihood? Farmer 6. How long have you followed such occupation of employment? All of my life 7. Have you followed such occupation or employment or any other occupation or employment, within the last two years? If so, state when and where, and the amount of you annual income from the same. None 8. State specifically the nature of your disability or disease. Old age Rheumatism in my elbows, knees, and shoulders. 9. What were the causes, which led to the disease which, has resulted in your disability? I don't know. 10. How long have you suffered from such disease and when did you first become aware that you were afflicted with the same? About 4 years. 11. With what disease or sickness did you suffer during the time of your service? None 12. Are you totally disabled because of such disease, or the infirmities of age, from following your usual and ordinary occupation or employment, or any other occupation or employment, by which to earn a livelihood? If not totally disabled thereby, but only partially, state the extent of your partial disability. I can do some light work but am easily broken down and exhausted. 13. When and where did you enter the service of Virginia, or of the Confederate States? May 1861, Clarksville, Virginia. 14. In what Co command and service were you engaged during the War Between the States? "G" 14th Va. Regiment, Armistead Brigade. 15. How long were you in the service? Until Appomattox April 9.1865. 16. When did you leave the service and under what circumstances? April 9,1865 when General Lee surrendered. 17. If suffering from disease, state what physician or physicians have attended you for the same. Have had no Physician. 18. Give the names and addresses of two or more in the service of your command, if such be living, and if not, so state. James F. Wilkins and J.G. Averett. 19. Give here any other information you may possess relating to your service, or disability that will support the justice of your claim for aid? Have stated it fully above. 20. Is there any camp of Confederate Veterans in the city or county of your residence? General L.A. Armistead Camp 21. Is there anyone living, the residence and address of whom is known to you, either comrade or otherwise, who has knowledge of you service and of the cause of your disability? If so or not, state. Thomas Wilson Houden, VA. Witness my hand this 19th Day of November, 1906. John B. Gold I, C. L Doggett ,a notary Public in and for the County of Mecklenberg in the State of Virginia do certify that John B Gold whose name is signed to the foregoing application, personally appeared before me in my County aforesaid and having the aforesaid application read to him and fully explained, as well as the statements and answers therein made, the said John B. Gold made oath before me that the said statements and answers are true. Given under my hand this 19 day of November 1906. C. L. Doggett, NP Oath of Resident Witnesses We, James F. Wilkins and G.H. Barbour , do solemnly swear that we are residents of the County of Mecklenberg, in the said State, and that we have known personally and well for many years. The applicant whose name is signed to the annexed application for aid under the act of the General Assembly of Virginia, approved April 9,1903, and that the said John B. Gold is a resident of the said county (or city), and is a man of good reputation for truth and honesty, and that we have read the annexed application and the answers to the questions therein propounded, made by the said applicant, and verily believe that the said applicant has been truthful in the said statements and answers, and that from our personal knowledge the applicant is disabled and that we verily believe the Said applicant is justly entitled to aid under that said act, and that we have no personal interest in the allowance of the applicant's claim. James F. Wilkins G.H. Barbour I, John A. Drake, a practicing physician in the County of Mecklenberg in the State of Virginia, do certify that I am personally acquainted with John B. Gold whose name is signed to the annexed application for aid under the act of the General Assembly of Virginia, approved April 2,1902, and that from a personal examination of the said John B. Gold, as to the disability set forth in his application and cause thereof, and if such disability be total, whether the applicant is deprived thereby of all ability to pursue his usual and ordinary occupation for a livelihood, or any other occupation for a livelihood, And if the disability were partial, to what extent the applicant is hindered thereby from pursuing such occupation as aforesaid. The disability is partial Rheumatism at times prevents him from manual labor sufficient to earn a living and his age is about 70 years and that the infirmity of age also adds to his disability, and that I verily believe his disability is wholly due to causes assigned in the said application, and that he is entitled to aid under the provisions of the said act, and that I have no personal interest in the allowance of the applicant's claim. Given under my hand, this 19 day of November 1906. J.A. Drake, MD Certificate of Camp of Confederate Veterans The L.A.Armistead Camp of Confederate Veterans of the County of Mecklenburg in the State of Virginia, hereby certifies that it has examined into the merits of the annexed application of John B. Gold for aid under the set of the General Assembly of Virginia, approved April 2, 1902, and being satisfied of the justice of his claim, hereby recommends the said, John B. Gold, for aid under the provisions of the said act, and that it has no personal interest in the allowance of the applicant's claim. Henry Wood, Jr.