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�my age & having one of my arms broken__ that family consists only of my wife ages sixty nine_ unable to work & my self & that I am wholly unable to support myself & have no other means to rely on except the Charily of my friends & the assistance of my County J M Blake [signature]

Sworn to & declared on the Eighteenth day of June A.D. 1830 Before me Nathan Weston Jur a justice of said court