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Bureau of Refugees, Freedmen, and Abandoned Lands.
THE UNITED STATES,
To A._____BC_____ Dt.

[[4 Columned Table]]
|1869|   |DOLLS.|CTS.|
|---|---|---|---|
|April 30" WASHINGTON, D.C.|For rent of room (or Building) occupied as an Office by the Supt of Education Bureau RF & AL at M______ A_____ from April 1" to April 30" 1869 inclusive one month at fifty dollars per mo  |50|00|
|   |Fifty 00/100 Dollars,|$50|00|

I CERTIFY, ON HONOR, that the above amount 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 ~~

[[blank signature line]]
Bvt. Maj. Gen., U.S.A., Commissioner

Received, at Washington, D.C. this ____ day of _____ 18___, from Bvt. Brig. Gen. GEORGE W. BALLOCH, Chief Disbursing Officer, Fifty Dollars and ~~~~ Cents, in full of the above account, by Check No. _____ on the United States Treasury, dated ______ 18___ .