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4/9/67

[[preprinted]]
WAR DEPARTMENT
Bureau Refugees, Freedmen, & Abandoned Lands.
CLAIM DIVISION.
POWER OF ATTORNEY.

In claim for
On account of
late a   in   Co.
Reg't   Vols.
Deceased or Discharged
  186

Claimant
Post Office

[The above blanks should be filled before sending to 
Central Office.]

Dated   186 .
Received  186 .
Filed  Office
  186 .

Pension Office, No.

(To be filled in all Pension Cases.)
[[/preprinted]]