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I, Rufus Galloway , a resident of Brunswick  County, N.C., am personallh acquainted with Carson Smith is , destitute and that he , [[strikethrough]]who[[/strikethrough]] resides in Brunswikc  County, N.C., and state, to the best of my knowledge and belief  , that  he is  unable to maintain himself and family   and that he has   no friends to assist him , and that he  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.