I William Little a pensioner under Pension Certificate No 90911 hereby apply for the arrears due me under the act granting arrears of Pension approved Janary 25th 1879. My post office address is P.O. Box 310 Bellaire Belmont county Ohio.
Two witnesses: James C. Falliuciu (signature) Howard Johnson (signature)
Name of Claimant William Little (signature)
State of Ohio County of Belmont
Signed in my presence by William Little who is known to me to be the Person he describes himselfe to be and at the same time he exhibited to me his pension certificate which is 90911.
James C. Falliucu (signature) Notary Public [Magistrate's signature]