
The image is a filled form titled "Officers Affidavit as to the Disability of a Soldier" from the state of Ohio, detailing an affidavit for a soldier named John H. Copus. The affidavit, dated June 26, 1877, is sworn by James Porter, who testifies about Copus’s injury sustained on January 21, 1862, during a battle near Munfordville, Kentucky. Copus, a private in Company G of the 21st Regiment Ohio Volunteers, received a wound to the right leg near the knee. The document states that prior to his injury, Copus was in good health, except for a minor week-long ailment, and was always ready for duty. James Porter, affirming his presence during the incident, held the rank of Lieutenant in Company G.