Physical description

Blue paper Memo A.O.F. Court King of the Forest No. 3770 dated Aug 11/1876. I hereby certify that C. Stoppelbein of Long Gully is able to follow his usual employment. Signed by ?. Signed at the end by C. Stoppelbein declaring himself off the sick Funds of the Court. Printed by J. Brockley, Printer, Bridge Street, Sandhurst.