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[[stamp]] THE NATIONAL ARCHIVES OF THE UNITED STATES [[/stamp]]

Georgia
Whitfield County

Before me personally appeared John Barclay and being duly sworn says that he is agent of the Inferior Court of said county for the distribution of provisions to the destitute in said county and that as such agent he delivered to Elizabeth Lacy one hundred and fifty pounds of corn between the 16th April & 1st May 1867
Sworn to and subscribed before me this 13 May 1867
John Barclay
Dawson S Walker
Judge Superior Court of Georgia