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[[right margin]] June 19, 67 [[/right margin]]
                                        Fort Johnson NC  June 19 1867
I, Samuel Freeman, a resident of Brunswick County, North Carolina, am personally acquainted with Annette Brown Widow destitute, who reside in Brunswick County, North Carolina, and state, to the best of my knowledge and belief, that she is and has no friends to assist her and is worthy of charity from the government, and is in danger of starvation if relief not given.
Samuel Freeman seal
Sworn and subscribed to before me, N Lyman Capt 20th US infy this 19 day of June, 1867
N Lyman Capt 20th US Infy
Note.- This Certificate must be signed and sworn before some officer or agent of this Bureau. Comdg Fort