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State of Virginia
City of Norfolk

On this 13th day of November 1865, before me the undersigned a Notary Public in and for the City aforesaid in the state aforesaid, personally appeared Richard Evans who, being by me first duly sworn, deposes and says, that he has read the President's proclamation of the 29th day of May 1865, and that the case of the said deponent is not embraced in any one of the exceptions therein contained, as he verily believe.
Richard Evans

Subscribed and sworn to before me the undersigned a Notary Public for the City of Norfolk Virginia, this 13th day of Nov. 1865. As witness my hand & seal of office.
Simon S. Stubbs
Notary Public

[[5 CENTS INTER. REVENUE CERTIFICATE stamp]]