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I, John Gore, a resident of Brunswick County, North Carolina, am personally acquainted with Peggy Clarity 2 children a destitute, widow who resides in Brunswick County, North Carolina, and state, to the best of my knowledge and belief, that she is unable to maintain herself and children, no friends to assist her and is worthy of charity form the government, and in danger of starvation if relief is not given.
John L Gore {seal}

Sworn and subscribed to before me, this 20 day of June, 1867
N Lyman Capt 20th US Infy
Note.-This certificate must be signed and sworn to before some officer or agent of this Bureau. Comdg Fort