The statement is witnessed by W. T. Bliss, Notary Public, and dated October 1, 1864. The document is in fragile condition. On the reverse side, Calkins signs a handwritten statement as to his identity, his truthfulness in providing facts, and his examination by Dr. Clark. The statement is witnessed by W. T. Bliss, Notary Public, and dated October 1, 1864. A brown 5 Inter.
Revenue stamp is attached.
On the reverse side, Balfour signs a handwritten statement as to his identity, his truthfulness in providing facts, and his examination by Dr. Clark. The statement is witnessed by William G. Bryan, Notary Public, and dated October 3, 1864. The document is not witnessed by a Notary Public and is undated. Dr. Norris G. Clark certifies that he, as State Examining Surgeon appointed by the Governor, has examined Levi Wright of the town of Alabama. The document is not witnessed by a Notary Public and is undated.