Form 1

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“ABSTRACT OF WITNESSES Name No. Certifi- cate No

Days Mileage Amount Due STATE OF ARKANSAS, County of . . . . . . . . .

I, . . . . . . . . . ., foreman of the Grand Jury, do solemnly swear that the above and foregoing is a true and correct abstract of the name of each witness who appeared and was in attendance before the Grand Jury, the number of days attended, and the amount due the same at the . . . . . . term of the . . . . . . . . . . Circuit Court, 20. . . . . .

Subscribed and sworn to before me this . . . . . . day of . . . . . . . . . ., 20. . . . . .

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