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Liverpool N.S.
Jany 28. 1861.

Queens County.
We the Overseers of the Poor for the Township of Liverpool do certify that Dr. Henry G. Farish has been authorized by us to attend the Indian mentioned in annexed account.

John [May?]
William Jackson
Alexander [Cowie?]
Lewis A. Sponagle

Henry G. Farish of Liverpool in the County of Queen's and Province of Nova Scotia Physician & Surgeon, maketh oath and saith that the annexed account for services to the Indian of Queens' County is just and true, and that the Charges in said account do not exceed the usual charge made by him in his profession
Sworn before me at Liverpool } Henry G. Farish
this 29 day of Jany 1861 }
Samuel T N [?Sellon] J.P.