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No. 12.
The United State,
To Bennent & Burbank Dr.
[[4 columned table]]
|Date of Purchase|   |Dollars|Cents|
|...|...|...|...|
|[[strikethrough]]18th[[/strikethrough]]|   |   |   |
|April 10th|1 Well Bucket|   |75|
|April 10th|1 Well Rope|3|00|
|May 5th|2 Sack Corn 280th,5bushel@$1.60|8|00|
|   |   |11|75|
For Service of Bureau RF and AL
at Greenville, Ala

I CERTIFY that the above account is correct and just, and that the articles have been accounted for on my property return for the month ending on the  of  , 186 .
Quartermaster.
RECEIVED at  , the  of  , 186 ,
Quartermaster United States
Army, the sum of Eleven dollars
and Seventy Five cents, in full of the above account.
(SIGNED IN DUPLICATE)
Bennent & Burbank