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Statement of Destitute in .......... County, State of Alabama, who are entitled to Rations under existing Regulations, and for whom no Rations have been drawn from the day of ......... 1866, to the ..... day of ........... 1866.

[[12 Columned Table]]
| WHITES. No. of Men. | WHITES. No. of Women. | WHITES. No. of Male Children under 14 years of age. | WHITES. No of Female Children under 14 years of age. | WHITES. Total Whites | BLACKS. No. of Men. | BLACKS. No. of Women. | BLACKS. No. of Male Children under 14 years of age. | BLACKS. No of Female Children under 14 years of age. | BLACKS. Total Blacks. | Aggregate Whites and Blacks. | REMARKS. |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |

Certify the the above statement of destitute in County [[blank line]], State of Alabama is correct.

Judge of Probate, .................... Co.

Transcription Notes:
The table and bottom text still has to be transcribed.