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I, Lewis A Galloway, a resident of Smithville, Brunswick County, N.C., am personalth acquainted with India McRackan, and 3 small, children destitute, colored, who reside near Smithville Brunswick County, N.C., and state, to the best of my knowledge and belief, that they are worthy and unable to maintain themselves and has no friends to assist them, and that they are worthy of charity from the government.

Galloway [seal]

Sworn and subscribed to before me, this 22 day of March, 1867
W.R. Dosher J.P

NOTE: This Certificate must be signed and sworn to before Magistrate, Justice of the Peace, or Officer of the army.