The State of ________ against ________, accused by the grand jury of the
county of ________, in the state of ________, by this indictment of the
crime of ________, committed as follows: 

The said ________, on the _____ day of ________, A.D. 18_____, at the city
of ________, in the county of ________, and state of ________, did,
without the authority of law, and with malice aforethought, ________,
contrary to the form of the statute in such case made and provided, and
against the peace and dignity of the state of ________.

Dated at the city of ________, in the county of ________, and state of
________, this _____ day of ________, A.D. 18_____.

A.L.H., Foreman of the Grand Jury.

Names of witnesses examined before the grand jury:  B.F.H., R.D.H., A.F.B.,
E.S., H.P.C., L.H.

NATURALIZATION PAPERS.

(First Paper.)

State of _______,}
County of ______}ss

I, ________, do solemnly declare on oath to ________, clerk of the
district court of the county of ________, and state of ________, that it
is bona fide my intention to become a citizen of the United States, and to
renounce forever all allegiance and fidelity to any foreign prince,
potentate, state or sovereignty whatever, and particularly to the
sovereign of ________, whereof I was heretofore a citizen or subject.

(Signed.)

Subscribed and sworn to before me this _____ day of _______, A.D. 18__.

Clerk of said Court.

State of _______,}
County of ______}ss

I hereby certify that the foregoing is a true copy of the original
declaration of _______, this day filed in my office.

In testimony whereof, I have hereunto subscribed my name and affixed the
seal of the district court aforesaid, at _______, this ____ day of
_______, A.D. 18__.

Clerk.

(Second Paper.)

State of _______,}
County of ______}ss

District Court, Judicial District.

Be it remembered, that on this ____ day of _______, 18__, _______ appeared
in the district court of the _____ judicial district of the State of
_______, and for the county aforesaid, the said court being a court of
record, having a common law jurisdiction and a clerk and seal, and applied
to said court to be admitted to become a citizen of the United States of
America, pursuant to the several acts of congress of the United States of
America for that purpose made and provided; and the said applicant having
thereupon produced to the court such evidence, declaration and
renunciation, and having taken such oaths as are by the said acts required: 
Thereupon it was ordered by the said court that the said applicant be
admitted, and he was accordingly admitted by the said court to be a
citizen of the United States of America.

In testimony whereof, I have hereunto subscribed my name and affixed the
seal of the court aforesaid, this ____ day of _______, A.D. 18__.

Clerk of said Court.