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Report in compliance with 
circular No 6 series 1866 form 
H'd Qrs Asst Comr. State of Virginia 
for 4th Division 1st Sub Dist Va Month of June 1867

[[seal]] STATE OF VIRGINIA BUREAU OF R.F.&A.L. HD QTR [[?]] COMMISSIONER JULY 6 1967 [[/seal]]

Transcription Notes:
Seal is faded; cannot transcribe missing word in stamp.