To John A. Smith Esq.Esquire, Clerk of the Circuit Court of the District of Columbia.
Sir:
Mrs Elizabeth Upsher of having claim to the service or labor of the undersigned, and having refused or neglected to file in your office the statement in writing or schedule provided for in the 9th section of the Act of Congress, entitled "An act for the release of certain persons held to service or labor in said District," approved April 16, 1862, you will please file this petition or schedule in lieu thereof, in pursuance of the provisions of an act supplementary to said act which said last mentioned act was approved July 12, 1862. This petitioner further state that the undersigned has resided in said District since the during 8 years and has resided therein since the 16 day of April 1862, by and with the consent of said Elizabeth Upsher
Name, Harry Upsher Age, about 60 Sex, male Remarks, Black 5 ft 11 inches
his X mark Harry Upsher
John F. Cook