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No. 22.
The United States,
To R C Furgeson    Dr.

[[4 Columned Table]]
| 1865. |   | Dollars. | Cents. |
| --- | --- | --- | --- |

| July 31st | For pay as Chief Clerk in Freedmens Bureau Dis'ct Selma Ala from the 19th day of June 1865 to 31st of July 1865 at $75,00 per month | 103 | 50 |

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

Sam'l S. Gardner
Asst Supt Freedmen's Bureau Disct Selma Ala

Received at ........, the .... of ......., 186 ,
Quartermaster United States Army, the sum of ......dollars and .... cents, in full of the above account.
(Signed in Triplicate.) ................

Transcription Notes:
tr - table formatted per SI Fixed left out words at bottom. Someone has copied and pasted this page to fill out, and there is a mistake.