Contributed by: Jo Huettl

SOLDIER’S APPLICATION FOR PENSION
STATE OF NORTH CAROLINA 
County of Jones
(Note that on this page J. B. Collins, CSC is at the head but it is signed by Plato 
Collins at end)
On this 3rd day of Sept, A. D., 1910, personally appeared before me J. B. Collins, 
C.S.C. in and for the State and county aforesaid, J W Burkett, age 82 years, and a 
resident at Dover, RFD #2 postoffice, in said county and State, and who, being duly 
sworn, makes the following declaration in order to obtain the pension under the provisions 
of an act entitled, “An act for the relief of certain Confederate Soldiers, Sailors and 
Widows,” ratified March 8, 1907; that he is the identical J W Burkett who enlisted in 
Co C, 27 Reg. N.C. State Troops on or about the 1st day of April, 1861, to service in 
the armies of the late Confederate States, and that while in said service at Reauns 
Station, in the State of Va, on or about the _____ day of ________ 186_, he received 
a wound or wounds, etc.

(Applicant will here state the nature and extent of his wounds and disability, so that a 
proper classification can be made under the new Pension Law passed by the General 
Assembly of 1907.  Read said section of said law carefully, and to accomplish the 
classification therein called for let statement here as to nature and extent of wounds, 
disability, etc., be very full and explicit).

Wounded over left eye – never been able to see much of that eye and now the other 
one is affected.

He further states that he is, and has been for twelve months immediately preceding 
this Application for Pension, a bona fide resident of North Carolina; that he holds no 
office under the United States, or under any State or county, from which he is receiving 
the sum of three hundred dollars as fees or as salary annually; that he is not worth in 
his own right, or the right of his wife, property at its assessed value for taxation to the 
amount of five hundred dollars ($500), nor has he disposed of property of such value by 
gift or voluntary conveyance since the 11th of March, 1885, and that he is not receiving 
any aid from the State of North Carolina or under any other statute providing for the relief 
of the maimed and blind soldiers of the State.

Sworn and subscribed to before me this 3 day of Sept, 1910

(signed) Plato Collins  Signature of C. S. C. (this is written in) of Lenoir Co.

(signed) his mark JW Burkett    Signature of Applicant.

Also personally appeared before W. D. Rayner , who resides at Kinston postoffice in 
said county and State, a person whom I know to be respectable and entitled to credit, 
and being by me duly sworn, says he is acquainted with J. W. Burkett, the applicant for 
pension, and has every reason to believe that he is the identical person he represents 
himself to be, and that the facts set forth in this affidavit are correct to the best of his 
knowledge and belief, and that he has no interest, direct or indirect, in this claim.

Sworn and subscribed to before me this 3rd day of Sept, 1910

(signed) Plato Collins  Signature of C. S. C. (this is written in) of Lenoir Co

(signed) W. D. Rayner  Signature of Witness.

Also personally appeared before me John A. Pollock a physician in good standing in 
the said county and State, and being duly sworn, says that he has carefully and 
thoroughly examined J. W. Burkett, the applicant for pension, and finds such disability 
for manual (end of this page JH)


STATE OF NORTH CAROLINA

Jones COUNTY.

To the Auditor of the State of North Carolina

We certify that we have carefully examined the application (this is written in JH) to 
increase pension of JW Burkett for pension under the provisions of an act entitled “An act 
for the relief of certain Confederate Soldiers, Sailors and Widows,” ratified March 8 1907, 
and the proofs filed in support thereof; that we are satisfied the said JW Burkett is the 
identical person who enlisted in Company C, 27 Regiment of NC Troops, on or about the 
1st day of April 1861, and who was disabled in a manner and to the extent stated in the 
foregoing certificates of himself and physician in consequence of a wound received in
battle on or about the ___day of __________, 186_, and we certify the following 
allegations set forth in his application to be true, namely:  That he is, and has been for 
twelve months immediately preceding this Application for Pension, a bona fide resident 
of North Carolina; that he holds no office under the United States, or under any State or 
county, from which he is receiving the sum of three hundred dollars as fees or as salary 
annually; that he is not worth in his own right, or the right of his wife, property at its 
assessed value for taxation to the amount of five hundred dollars ($500), nor has he 
disposed of property of such value by gift or voluntary conveyance since the 11th of 
March, 1885, and that he is not receiving aid from any other source from the State of 
North Carolina, and therefore his application is correct and just under the act.

(SEAL) (signed) JB Collins
Clerk Superior Count.

(IMPRESS COUNTY SEAL HERE).

Approved:

(signed) W. C. Kinsey
(signed) JW Wootin
(signed) F.M. Dixon
 County Pension Board





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