____________
Secretary of War.
To ____________
____________, 1868.
To the Honorable Secretary of War,[4] Washington, D. C.
Sir: I hereby respectfully acknowledge the receipt of your notification of my contemplated appointment as a Cadet of the United States Military Academy, with the appended circular, and inform you of my acceptance of the same upon the conditions named.
I certify, on honor, that I was born at ________, in the County of ________, State of ________, on the ____ day of ________, 18__, and that I have been an actual resident of the Congressional District of ________ for __ years and __ months.
(Signature of appointee) ____________
I hereby assent to the acceptance by my ________ of his conditional appointment as Cadet in the military service, and he has my full permission to sign articles binding himself to serve the United States eight years, unless sooner discharged.
I also certify, on honor, that the above statements are true and correct in every particular.
(Signature of parent or guardian) ____________