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I, J.A. Walker, a resident of New Hanover County, N.C., am personally acquainted with Nancy Walker (colored) aged, 80 & destitute colored woman, who reside in Brunswick Co [[strikethrough]] County [[/strikethrough]] 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 that she is worthy of charity from the government.
J.A. Walker {SEAL}

Sworn and subscribed to before me, .... , 26 this 26 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.