The First Church in South Hadley Mass
to the Church in Manlius New YorkRev & Beloved
This may certify that Miss Harriet W. Cushman is a member of this church in good & regular standing[.]
At her own request she is hereby dismissed & recommended to your watch & care & when so recieved [sic] by you her particular relation to us will be at an end[.]
T Laurie Pastor
S. Hadley Sept 26 1850