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Know all Men by these Presents, That ...., of the Country of ...., State of ...., .... held and firmly bound to the UNITED STATES OF AMERICA in the sum of .... dollars, for the payment of which .... bind .... HEIRS, EXECUTORS, AND ADMINISTRATORS, firmly by these presents, in this contract: that .... to furnish the persons whose names are subjoined (freed laborers) quarters, full , substantial, and healthy rations, all necessary medical attendance and supplies in case of sickness, and the amount set opposite their respective names per month, during the continuation of this contract. The laborers to be paid in full before the final disposal of the crop, which is to be raised by them on .... plantation, in the County of ...., State of .... .

[[10 columned table]]
NO.|NAMES.|AGE.|RATE OF PAY PER MONTH. DOLLS.|PAY PER MONTH CTS.|NO.|NAMES.|AGE.|RATE OF PAY PER MONTH. DOLLS.|PAY PER MONTH CTS.|
---|---|---|---|---|---|---|---|---|---|

[[stamp]] THE NATIONAL ARCHIVES OF THE UNITED STATES [[/stamp]]


This contract is to commence with this date and close with the year.
 
Given in duplicate, at .....
this .... day of ...., 1865.
............................
............................
Supt. of Dist.

WITNESS. {..................
{...........................
                                                      
Registered at ....., 186.