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[[left margin]] June 20, 67 [[/left margin]]

I, J.C. Russell, a resident of Brunswick County, North Carolina, am personally acquainted with Mrs Rebecca Harriss destitute, widow who reside in Brunswick County, North Carolina, and state, to the best of my knowledge and belief, that she is unable to maintain herself and she has no friends to assist her and that she is worthy of charity from the government, and   in danger of starvation if relief is not given.

JC Russell {Seal}

Sworn and subscribed to before me,    this 20 day of June, 1867

W Lyman Capt 40th US Infy Comdg Fort

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