8 1/2 x 6 1/2, imprinted form, filled out in ink.

To the Board of Relief of Somerset County, Elisabeth Diedrick, wife of John Diedrick, of Addison township, Somerset County, Pa., who is a member of Capt. John Bierer's company K, 6 Pa. Artillery, 212 Regiment Pennsylvania Volunteers, now in the service of the United States on whom she is dependent for support, claims relief under the Act of Assembly of 15th May A.D. 1861. Entered service on the 2 day of September A.D. 1864. No. of family, three- herself and two children all under ten years of age, the oldest eight years old next January 1865. Elisabeth Diedrick. The document is signed by two witnesses who appeared before A. Hanna, Justice of the Peace of Somerset County. It is also signed by Hanna and dated 6th November 1864. Notation at the bottom: $7.50 this amt. issued for 5 months up to the 7th of Feby. 1865 at the rate of $1.50 per month. Light age toning, and wear, and some ink smears.

John Diedrick, also spelled Deiterich on the Pennsylvania muster rolls, served in Battery K, 6th Pennsylvania Heavy Artillery, and was mustered out of the Union Army on June 13, 1865, at Fort Ethan Allen, Va.