Applications such as this were completed by residents of Confederate States after the Civil War. The purpose of the applications was to remove political disabilities imposed by Section 3 of the 14th Amendment, which prohibited individuals who had been active in the rebellion from eligibility for government employment. The applications were later collected by the Select Committee on Reconstruction, which was established in 1867.
This specific application was completed by Ira Garrett of Virginia and states that he previously served as a court clerk in Virginia, and gave no support to the rebellion other than sympathy to the hungry and sick. He adds that he accepts the political situation of the country, is now a Republican, and endorses the Reconstruction policy of Congress. Virginia would not have representation in Congress until 1870, when it was readmitted to the Union.