856 



FORM B. 



FOR CASES WHERE THE LAND CLAIMED SHALL HAVE BEEN RENDERED 

 SUBJECT TO PRIVATE ENTRY SINCE THE DATE OF THE LAW. 



I, A. B., of . , being [the head of a 



family, or widow, or single man, over the age of twenty-one years, as 

 the case may be, a citizen of the United States, or having filed my 

 declaration to become a citizen as required by the naturalization laws, 

 as the case may be,] have since the first day of , A. D. 



184 , settled and improved the quarter of section number 



, in township number of range number 



in the district of lands subject to sale at the land-office at t 



and containing acres, which land has been rendered sub- 



ject to private entry since the passage of the act of 4th September, 

 1841, but prior to my settlement thereon ; and I do hereby declare my 

 intention to claim the said tract of land as a pre-emption right, under 

 the provisions of said act of 4th September, 1841. 



Given under rny hand, this day of 



A. D. 184 . 



(Signed) A. B. 



In presence of C. D. 



FORM C. 



FOR CASES WHERE, AT THE DATE OF THE LAW, THE LAND CLAIMED 

 WAS SUBJECT TO PRIVATE ENTRY. 



I, A, B., of , being [the head of a family, or 



widow, or single man, over the age of twenty-one years, as the case 

 may be, and a citizen of the United States, or having filed my declara- 

 tion to become a citizen as required by the naturalization laws, as the 

 case may be,] have, since the first day of June, 1840, to wit : on the 

 day of , A. D. 184 , settled and im- 



proved the quarter section, number , in town, 



ship number , of range number , in the dis- 



trict of lands subject to sale at the land -office at , and 



containing acres, which land was subject to private entry 



at the passage of the act of 4th September, 1841 ; and I do hereby 

 declare my intention to claim the said tract of land as a pre-emption 

 right under the provisions of said act of 4th Semptember, 1841. 



Given under my hand, this day of 



A. D. 184 . 



(Signed) A. B, 



In presence of C. D. 



