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State of Virginia
York county, to wit.

On this 6th day of January, 1867, before me, Edw. C. Darlington, a justice of the peace for said county, personally came. Allen Davis, who being sworn doth declare and say, that he does not come within any of the excepted classes, enumerated in the proclamation of the President of the United States, granting pardon and amnesty to all citizens of the States lately in rebellion. Sworn and subscribed, the date above written.
                                  Allen Davis
             Coram Edward Darlington
                                 J.P.

Transcription Notes:
coram judice adverb (or adjective) : before a judge having jurisdiction