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0422

State of Alabama
Madison County
p__

On this 27th day of October 1865 personally appeared before me this clerk of the United States District Court for the Northern District of Alabama, Elias Robinson a freedman the applicant above named and James Pollard and Reuben Street the witnesses thereto, who being duly sworn acknowledges and signed the same before me this day and year frist above written; and I further certify that I have no interest direct or indirect in the prosecution of this claim. This testimony whereof I have hereunto set my hand and affixed the seal of the said District Cout this day and year above written.
John H King
Clerk

[[stamp]]
US
INTER. REVENUE.
5 5
FIVE CENTS.
[[?]] 1865 [[?]]
5 5
INL. D EXCHANGE
[[/stamp]]