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I, Chas Moore, a resident of Brunswick County, North Carolina, am personally acquainted with Runty Galloway 4 children destitute, who reside in Brunswick County, North Carolina, and state, to the best of my knowledge and belief, that he is unable to maintain himself and family no friends to assist him and   worthy of charity from the government, and   in danger of starvation if relief is not given.

Chas his X mark Moore {Seal}

Sworn and subscribed to before me, W Lyman Capt 40th US Infy this 19th day of June, 1867

Wyllys Lyman Capt 40th US Inft Comdg Fort 

Note. - This Certificate must be signed and sworn to before some officer or agent of this Bureau.