State of Kentucky
Jefferson County } ss

This day Thomas Forman, personally appeared before the undersigned a Justice of the Peace for said County, and made oath, That on the first day of July last, That He was robbed, in the city of Louisville in said County & State, of a watch and chain of the value of Five Hundred dollars, and of the following description viz, a Gold watch with Magic case, with the name of William Reader engraved on the back of inside case, also thea square and compas, and three links engraved upon the back of said case, The chain was a heavy gold one usually called a Vest chain. affiant further states that he has good grounds to believe, and does believe, That the said watch and chain, was stolen taken and carried off from his person, and out of his possession by one Mathew Skifington, and that from reliable information received by this affiant he has good reason to believe, and does believe, that said Skifington is now residing in the Town of Peoria, in the County of C [...] and State of Illinois, and He prays that a writ be issued for his arrest and return to said State, that he may be made to answer the charge of Felony —

Thomas ^his X mark^ Forman

The within affidavit was sworn to and subscribed by Thomas Forman before me this 12th day of October 1865

Saml Matlack J. P. J. C

State of Kentucky
Jefferson County } SS.

I, T. Jack Conn clerk of the county Court of Jefferson County in the state of Kentucky do certify that on this Sam^l Matlack whose genuine signature appears to the foregoing certificate is now and was at the time of signing the same an acting Justice of the peace in and for said county duly elected and qualified and that all of his official acts as such are entitled to full faith and credit.

{JEFFERSON COUNTY
KENTUCKY}

Witness my hand this 12^th day of October 1865

T. Jack Conn Clerk
By Alex Willey D.C