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[[left margin]] June , 67 [[/left margin]]
Fort Johnson NC June 19 67

I, May Shepard, a resident of Brunswick County, North Carolina, am personally acquainted with    destitute Betty Keleau, who reside Brunswick County, North Carolina, and state, to the best of my knowledge and belief, that she is unable to maintain herself & family and has no friends to assist her and   is worthy of charity from the government, and is in danger of starvation if relief is not given.

May hisXmark Shepard  {Seal}

Sworn and subscribed to before me, W Lyman Capt 40th US Infy this 19 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.