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Dr. Crisp for the services of myself and wife and boy from that day to this. 

Henry Chavers  his x mark

Witness
John Williams
Sergt "C" Co 6th U.S. Cav.

Sworn & subscribed to before me this 7th day of October 1867
Enon M. Harris
S.A. Comr. Bur. R.F. & A.L.