Form that new soldiers, politicians, and civil servants had to fill out and sign after North Carolina's secession, by which they pledged loyalty to the state and renounced their loyalty to the United States.
Having been appointed a
I do hereby accept the same and certify that I am _______ years of age;
that I was born in ___________________________
and that my residence when appointed was ___________________________
the nearest post office being ___________________________
I do swear that I will be faithful and bear true allegiance to the State of North Carolina, and to the Constitutional powers and authorities which are or may be established for the government thereof, and maintain and defend the Constitution of the said State. So help me God.
Subscribed and sworn to before me,
________________________________________, J. P.
This _____________ day of ______________________________ 1861.
NOTE. -- This leaf to be detached and sent to the Adjutant-General.