The State of Ohio Wood County ss
On this 29 day of August A.D. 1879 personally appeared before me W. S. Eberly, Clerk of the Court of Common Pleas within and for the county & state aforesaid Samuel Shroyer who being duly sworn makes oath and says that he can not furnish the affidavit of any physician for June 1865 to October 1866 but that he herewith sends the affidavit of two of his neighbors as to his condition.
Samuel Shroyer
His mark
Sworn to before me and in my presence subscribed this 29 day of August A.D. 1879 & I hereby certify that I am not interested in the prosecution of this claim.
W. S. Eberly Clerk