Certificate of Disability for Discharge
ARMY OF THE UNITED STATES OF AMERICAN
CERTIFICATE OF DISABILITY FOR DISCHARGE
(To be used, in duplicate, in all cases of discharge on account of disability.)
Hiram K. Blanchard Private of Captain Charles Jarvis Company, (D) of the Ninth Vermont Regiment of United States Volunteers was enlisted by A. J. Dyke of Woodstock Regiment of Vermont at Woodstock Vermont on the 28th day of May 1862 to serve three years; he was born in Royalton in the State of Vermont is eighteeen years of age, five feet seven and a half inches high, light complexion, blue eyes, dark hair, and by occupation when enlisted a farmer. During the last two months said soldier has been unfit for duty sixty days. (Here consult directions on Form 13, p. 325, Medical Dept. Gen. Reg.)
Said Blanchard's disaiblity appeared at Winchester Va. in August last while at work on fort & has rendered him useless to the service since & there is no probability of his being otherwise.
Station: Camp Tyler, Chicago, Ill.
Date: 13 Novr 1862.
I certify, that I have carefully examined the said H K Blanchard of Captain Jarvis Company, and find him incapable of performing the duties of a soldier because of (Here consult par. 1233, p. 284, and directions on Form 13, p. 325, Med. Dept. Gen. Reg.)
Chronic rheumatism & general disability. In my opinion said difficulty was caused by explosion while on duty in Aug last. He should - I Think - be discharged from the service. Degree of disability one fourth (1/4).
Discharged this 20th day of November 1862, at Chicago Illinois
Note 1. -- When a probable cause for pension, special care must be taken to state the degree of disability.
Note 2. -- The place where the soldier desires to be addressed may be added here.
[A.G.O. No. 100 & 101]