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[[4 column table]]
|NAMES.|AGE.|No of Dependents| Remarks|
|---|---|---|---|
|Adison X|15|    |    |
|Esther X|32|    |    |
|Charlotte X|25|1|    |
|Eliza |30|4|    |
|Miles X|20|    |   |
|Bill X|14|   |   |
|Ellick X|12|   |   |
|Mariah X|12|   |   |
|Sam |12|   |   |
|Malinda |22|3|   |
[[/4 column table]]

Executed in Presence of William G Jordan
William B. Richy
Ruben Jordan

[[sideways bottom of page]]
Jordan, Wm. G
August 4" 1865
[[/sideways bottom of page]]