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I, Samuel Freeman, a resident of Brunswick County, North Carolina, am personally acquainted with Phillis Galloway who has two young children destitute, and 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 family no friends to assist her and is worthy of charity from the government, and is in danger of starvation if relief is not given.
Samuel Freeman SEAL
Sworn and subscribed to before me,  this 19th day of June, 1867
W Lyman Capt 20th US Infy Comdg Fort
NOTE.- This Certificate must be signed and sworn to before some officer or agent of this Bureau.