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Bureau of Refugees, Freedman, and Abandoned Lands.
THE UNITED STATES,
To: A ~ B ~ C ~ Dt.

[[4 Columned Table]]
|1869|   |Dolls.|Cts.| 
|---|---|---:|:---|

|April 30" Washington, D.C.|For: Services as Clerk to the Supt of Education. Bureau R.F. and A L. In the State of from April 1" to April 30" 1869 inclusive - one month at one hundred dollars per month.| 100|00 |
|   |Less Int Rev Tax|   |83  | 
|   | $ |   |   |
|   |Ninety-Nine 17/100 Dollars,| 99|17 | 

I certify on honor, that the above account is correct and just; that the services were rendered as stated, and were necessary for the public service.

Approved, and ordered paid.
Supt of Education State of

Bvt. Maj.-Gen. U.S.A. Commissioner.

Received at WASHINGTON, D.C., this ___day of  18__ , from Bvt. Brig.-Gen. GEORGE W. BALLOCH, Chief of Disbursing Officer, Ninety-nine Dollars and seventeen Cents, in full of the above account, by Check No. ____ on the United States Treasury, dated _____ 18__.

[SIGNED IN DUPLICATE.] A ~ B ~ C ~.

Transcription Notes:
formatted table per SI, removed lines on page not required Style sheet says to use |---:| for right-aligned; |:---| for left-aligned.