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Printed form dated 31 August 1865. Declaration made by Henry Bollman of Sandhurst that he was under the age of 23, married and that the age of his wife did not exceed 22 years and that they didn't have any infirmity likely to shorten the natural duration of life. Signed by Henry Bollman and also by H. L. Atkinson mentioning that he had examined the above Candidate.
