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Fort Johnson N.C. June 20, 1867

I, Alfred Simmons, a resident of Brunswick County, North Carolina, am personally acquainted with Delia Davis widow with three children destitute,  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. 

Alfred Simmons [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. 

Transcription Notes:
Unable to make out Alfred's last name.