Page:A certificate for the electoral vote for Rutherford B. Hayes and William A. Wheeler for the State of Louisiana dated 1876 part 3.jpg



Be it remembered, that on the day of  in the year 1876, personally came before the Supervisor of Registration for the Parish of West Feliciana  who, being duly sworn, doth depose and say as follows, to wit:

My name is I was born at   in the year  my occupation is  and I reside at    I am a citizen of Louisiana, and have been residing in this State ever since the  day of, in the year  I was duly registered in the election precinct of the Parish of West Feliciana, in the month of  1874 No.  and the certificate of registration issued to me at that time has been lost or destroyed, I have no other place of residence, and I did not remove to the said election precinct for the purpose of voting therein, but for the purpose of making it my place of residence, in pursuance of my lawful calling.

Sworn and subscribed to, this day of

A.D. 1876 before me,