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Personally apeared before me H.Hull Jr. who being duly sworn doth depose and say that he is a union man and has never given aid, comfort or sympathy to the rebellion or enemies of the United States Government, and that he does not come under the requirements of a pardon or amnesty oath. 

H. Hull Jr. 

Sworn to and subscribed before me this ninth day of December 1865. 

[[JS Shmith?]]
[[1st ?]]
Asst. Supt. Eliz. City Co Va