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[[preprinted]]
No.   Page 
Date  
Name  
Age , No. of dependents 
Residence  
Occupation  
Formerly belonged to  
Issued by

Freedmen's Certificate of Enrollment, issued in accordance with General Order No. 5, Paragraph V, office Assistant Commissioner Freedmen's Bureau for the State of Mississippi.

No.
Office Sub-Commissioner Freedmen's Bureau,

Meridian, Miss.,  day of  1865.
, age , No. of dependents
Residence,
Occupation, 

Sub Commissioner

☞ This Certificate to be renewed monthly or upon change of residence. ☜
[[/preprinted]]