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[[preprinted]]
Department of the Interior,
OFFICE OF INDIAN AFFAIRS
Washington, [[blank line]], 188^[[blank line]]

[[boxed]]
Refer in reply to the following
[[blank line]]
[[/boxed]]
[[/preprinted]]

[[table]]

   |   |   |
Dead   |68 |  69
Fictitious [[?]] in. |  71 |  71
"[[ditto for Fictitious]] recovered| 214 | 214
Retained |  43 |  49
Assigned |  74 |  75
Dead & no heirs| [[underlined]|  5 | 7 [[/underlined]] 

   | 475 | 475