Peter Pixler Application for Reimbursement

This form is really long, so I'm only transcribing the genealogically pertinent info.

Questions answered by Amos Pixler, aged 58 years, a resident of Roosevelt, County of Kiowa, State of Oklahoma.

Makes the following declaration in order to obtain reimbursement from the accrued pension for expenses paid (or obligation incurred) in the last sickness and burial of Peter Pixler.

What was your relation the the deceased pensioner? son
Are you married? no
What was the cause of pensioner's death? old age and general dibility [sic]
When did the pensioner's last sickness begin? about a week before death
From what date did the pensioner become so ill as to require the regular and daily attendance of another person constantly until death? July 22, 1917
Give the name and post-office address of each physician who attended the pensioner during last sickness Dr. F. F. Martin, Roosevelt, Okla.
State the names of the persons by whom the pensioner was nursed during the last sickness Clyda Pixler and myself
Where did the pensioner live during last sickness? lived at my home
Where did the pensioner die? at my home
When did the pensioner die? July 29, 1917
Where was the pensioner buried? at Roosevelt, Okla.

State below the expenses of the pensioner's last sickness and burial.

Dr. F.F. Martin Physician Unpaid $4.00
C. L. Brown Furn. Co. Undertaker Unpaid 45.00
Town of Roosevelt Cemetery Paid $10.00
Gresham & Co. Articles for burial Paid .75

Also appeared D.W. Tate and ________ who being duly sworn, say that they saw Amos Pixler, the claimant sign his name to this application; that they know the claimant herein and that their answers to the following questions are true:

1. Did pensioner (if a soldier or sailor) leave a widow or a minor child under age of sixteen years surviving? No
2. When did the pensioner die? July 29, 1917
3. Did pensioner leave any property? If so, state its character and value No
4. We knew pensioner one years. We believe above statements to be true because we have often talked with deceased and also with claimant as to affairs pertaining to his business and have lived adjoining farms to him for more than one year

Name D. W. Tate
P.O. Address Roosevelt, Okla

Name J. D. Griffs
P.O. Address Roosevelt, Okla