New-York, [blank] This is to certify, that the bearer [blank] has, in my presence, subscribed to the declaration, agreeable to the terms of their Excellencies the Commissioners proclamation, dated at New-York, 30th November, 1776
New-York, This is to certify, that the bearer has, in my presence, subscribed to the declaration
New York, [blank] This is to certify, that the bearer [blank] has, in my presence, subscribed to the declaration