State of Illinios Stephenson Co town of Buckeye
I, Jefferson Moses born in Somerset Co
in the State of Pennsylvania aged nineteen years, and by occupation a
Farmer Do HEREBY ACKNOWLEGE to have volunteered this twelfth
day of August 1862 to serve as a SOLDIER in the Army of the United
States of America, for the period of THREE YEARS, unless sooner discharged by proper
authority: Do also agree to accept such bounty, pay, rations, and clothing, as are, or may
be, established by law for volunteers. And I, Jefferson Moses
do solemnly swear that I will bear true faith and alliegiance to the UNITED STATES OF
AMERICA, and that I will serve them honestly and faithfully against all their enemies
or opposers whomsoever; and that I will observe and obey the orders of the President of
the United States, and the orders of the officers appointed over me, according to the Rules
and Articles of War
Jefferson Moses
Sworn and subscribed to, at Cedarville this twelfth day of
August 1862, before J. Richart, J.P.
I Certify, on Honor, That I have carefully examined the above named Volunteer, agree-
able to the General Regulations of the Army, and that in my opinion he is free from all
bodily defects and mental infirmity, which would, in any way, disqualify him from performing the duties of a soldier.
Examining Surgeon (left unsigned)
I Certify, on honor, That I have minutely inspected the Volunteer,
previously to his enlistment, and that he was entirely
sober when enlisted; that, to the best of my judgment and belief, he is of lawful age; and
that, in accepting him as duly qualified to perform the duties of an able-bodied soldier, I
have strictly observed the Regulations which govern the recruiting service. This soldier has grey eyes, brown hair, dark complexion, is 5 feet 8 1/2 inches high.
Regiment of (uncompleted) Volunteers,
Recruiting Officer

(On the reverse side of the form is a Declaration of Recruit of his age. There is also a Consent portion to be completed in event the recruit is a minor).