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STATE OF MARYLAND BOUNTY.
FREE COLORED VOLUNTEERS

State of Maryland,} Set.
City of Baltimore,} 

Be it Remembered, That on this ... day of ... A.D. 1868, before me, the subscriber, Clerk of the Superior Court, in and for the City and State aforesaid, personally appeared ... aged ... years, who being duly sworn according to law, does, on his oath, make the following declaration in order to obtain the benefits of the provisions made by the Acts of the General Assembly of Maryland, of 1864, chapter 15, and amendments thereto, and supplementary Acts of the General Assembly of Maryland of 1867, passed March 22, 1867, and March, 1868, and amendments thereto, that he was a ... of Company ... Regiment United States Colored Volunteers: that he volunteered or enlisted on or about the ... day of ... A.D. 186 , for three years or during the War; that he never deserted from the said service of the United States, but continued in the same until the ... day of ... 186 , when he was honorably discharged there from at ... by ... and that at the time of his enlistment, as aforesaid, he was a free eprson, and had been free for more than ... years.
The declarant's Post Office address is ... 
He therefore applies for the sum of ... dollars, to which he is entitled, and hereby irrevocably constitutes and appoints HUGH L. BOND, of Baltimore, his Attorney in fact and agent to receive and receipt for the same, hereby revoking any powers of Attorney by me heretofore given.

... (Signature of Claimant.)

ATTEST 
(Two Witnesses.)
... (Signatures of Witnesses.)

Sworn, subscribed and acknowledged before me, the day and year first above written, and I certify that the affiant .... is known to me to be the identical person he represents himself to be, and I believe that the facts stated are correct. I further certify that I have no interest in this claim.
At the same time personally appeared before me ... residing at ... and ... residing at ... whose names are also signed to said declaration, as subscribing witnesses thereto. who are known to me to be persons of respectability, and entitled to full credit as witnesses, and who, being duly sworn according to law, depose and say, that they are personally well acquainted with the said ... whose name is signed to the aforegoing declaration, and know him to be the identical person who served as a ... in Company ... regiment U.S. Colored Volunteers, and that they derive their knowledge of these facts from personal acquaintance with said ... for ... years past,  and that they have no interest in this claim.

... (Signatures of Witnesses.)