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I, Rebecca Moore, a resident of Wilmington Hanover County, N.C., am personally acquainted with Negro Mary Moore old and destitute Freedwoman, who resides at Clarendon Plantation - Brunswick County, N.C., and state, to the best of my knowledge and belief, that she is unable to maintain herself, and has no friends to assist her, and therefore is worthy of charity from the government.
R Moore {SEAL}

Sworn and subscribed to before me, ....., this 29 day of June, 1866.

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