This transcription has been completed. Contact us with corrections.
[[preprinted]] I [[blank]], a resident of [[blank]] County, N. C., am personallh acquainted with [[blank]], destitute [[blank]], who reside [[blank]] County, N. C., and state, to the best of my knowledge and belief [[blank]], that [[blank]] unable to maintain [[blank]], and [[blank]] no friends to attest [[blank]], and [[blank]] worthy of charity from the government. [[blank]] [[flourish surrounding word]] SEAL [[/flourish surrounding word]] Sworn and subscribed to before me, [[blank]], this [[blank]] day of [[blank]], 1866. [[scroll-like line across page]] Note-This Certificate must be signed and sworn to before some Magistrate, Justice of the Peace, or officer of the army. [[/preprinted]]