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The Pamphlet Collection of Sir Robert Stout: Volume 43

United States of America, _______District of._______

page 28
United States of America, _______District of._______

I,____, the petitioner mentioned and described in the foregoing petition, do hereby make solemn____that the statements contained therein are true, so far as the same are stated of my own knowledge, and that those matters which are stated therein on information and belief are true, according to the best of my information and belief.

____ Subscribed and____to before me, on this____day of____A. D. 187____ [Signature of Judge, Register, or United States Comissioner.]