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L. 186. R.F.&A.L. Va. 2d Vol. 1867. 

Bu R. F. and A. L
Hd: Qrs: 7th Sub-Dist: Va, 
Lynchburg Va May 29, 1867. 

Lacy, R. S. 
Capt: & Agent. 

Returns "Oath" properly executed, of J.B. Work clerk. 

[[stamp]] STATE OF VIRGINIA. BUREAU OF R. F. & A. L. *** RECD. HD. QRS. ASST. COMMISSIONER. 3 JUN 1867 [[/stamp]]