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I, Rufus Galloway , a resident of Brunswick  County, N.C., am personally acquainted with Mary Power that She is [[strikethrough]],[[/strikethrough]] destitute  , [[strikethrough]]who[[/strikethrough]] resides in Brunswick  County, N.C., and state, to the best of my knowledge and belief  , that she is   unable to maintain herself   and that she has   no friends to assist her , and that she is  worthy of charity from the government.

Rufus Galloway   {Seal}

Sworn and subscribed to before me,  , this   day of  , 1866.

 

Note. - This Certificate must be signed and sworn to before some Magistrate, Justice of the Peace, or officer of the army.