Philadelphia, [blank] 1862. To [blank] : Sir: You will please take notice that you have been enrolled as liable to military duty. If you claim you are not liable, on account of physical defect or bodily infirmity, or that you are exempt from the performance of military duty by any law of this state or of the United States, it will be your duty, on or before the [blank] day of [blank] 1862, to deliver to either of the undersigned, at their residence, [blank] an affidavit, stating such facts on which you claim to be exempt, or not liable to such military duty. [blank] [blank] assessors.