State of New York, County of Cayuga, ss:
Sworn to and subscribed before me this day by the above named affiant , and I certify that I read said affadavit to said affiant , including the words _____________________________ _________ erased, and the words ______________________________ _________ added, and acquainted her with its contents before she executed the same. I further certify that I am in nowise interested in said case, nor am I concerned in its prosecution; and that said affiant is personally known to me and that she is a credible person .
I, _______________________________________ Clerk of the County Court in and for aforesaid County and State, do certify that ____________________________________ Esq., who has signed his name to the foregoing declaration and affidavit, was, at the time of so doing __________________________________ in and for the said County and State, duly commissioned and sworn; that all his official acts are entitled to full faith and credit, and that his signature thereunto is genuine.
Witness my hand and seal of office, this ___________ day of _______________________, 18__
[L. S.] ____________________________________
Clerk of the _________________________
☞ To be executed before a Court of Record or some officer thereof having custody of its seal, a Notary Public, or Justice of the Peace, whose official signature shall be verified by his official seal, and in case he has none, his signature and official character shall be certified by a Clerk of a Court of Record, or a City or County Clerk.
Late Harriet Tubman
Printed and For Sale by J. F. Shetry, Claim Blank Printer, 623 D Street, N. W., Washington, D. C.