| Surname | Given | Middle | Cause | Monthly Rate | Certificate No. | Original Date | Post Office | County |
| ARNOT | | Truman | g.s.w.l.foot | $4.00 | 23243 | ???. | Achill | Roscommon |
| CADY | R. | John | inj.r.leg | $6.00 | 142983 | ????? | Roscommon | Roscommon |
| DUNBAR | B. | Alvin | g.s.w.l.shr. and lung dis. | $5.00 | 106642 | Nov. 1870 | Edna | Roscommon |
| EVERTON | | James | g.s.w.l.arm | $4.00 | 136945 | ????? | Roscommon | Roscommon |
| FULLER | | William | g.s.w.r.thigh | $4.00 | 134736 | ?????. | Roscommon | Roscommon |
| GARRISON | B. | Samuel | g.s.w.l.foot | $4.00 | 158890 | Apr. 1879 | Roscommon | Roscommon |
| GIBBON | A. | Octavia | widow | $20.00 | 53616 | ????? | Roscommon | Roscommon |
| GIFFORD | S. | Benjamin | disease of lungs | $4.00 | 175194 | ?????. | Roscommon | Roscommon |
| HALE | | William | Ch.diarr | $2.00 | 134849 | July 1875 | Edna | Roscommon |
| HAMILTON | A. | Hugh | g.s.w.r.thigh | $6.00 | 133637 | ????? | Roscommon | Roscommon |
| RICHARDSON | | Julius | dis.of abdominal viscera | $12.00 | 148995 | Oct. 1877 | Roscommon | Roscommon |
| SMITH | P. | Alvin | chr.diarrhea | $8.00 | 107791 | Feb. 1875 | Roscommon | Roscommon |
| TORUS | | Myron | w.r.hand | $6.00 | | ????? | Roscommon | Roscommon |
| TORUS | | Myron | w.r.hand | $6.00 | | ????? | Roscommon | Roscommon |
| WALTERS | | Israel | g.s.w.l.hand | $14.00 | 13067 | ????? | Roscommon | Roscommon |
| WELCH | | John | ???.. | $15.00 | 9659 | ????? | Roscommon | Roscommon |
| WHITE | J. | Uriah | ch.diarr | $6.00 | 116421 | ????? | Roscommon | Roscommon |