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[[4 columned table]]
| Names | Age | No. of Dependents | Remarks |

| Landers his X mark | 53 | 1 |   |
| Milly her X mark | 45 |   | Has done no work for five years and will not be able to do anything because of diseases |
| Peter his X mark | 12 |   |   |
| Columbus his X mark | 11 |   |   |
| Tom his X mark | 29 |   |   |
| Halda hr X mark | 28 |   |   |
| Jim his X mark | 11 |   |   |
| Wash his X mark | 25 |   |   |
| Mary her X mark | 28 | 4 | [[strikethrough]] Eight Months [[/strikethrough]], pregnant |
[[/4 columned table]]

Executed in Presence of G.W. Brame
R.S. Harris

No. 173
Rebecca Brock
B 173
15-9