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2
NO. 141.
The United States,
To........................Dr.
[[four columned table]]
|Date|
|For actual cost of transportation of myself from..........
to.............as per annual statement|
|Dolls.|
|Cts.|
[[/four columned table]]

I certify that I performed the above journey for the purpose of entering upon my duties as Teacher in Freedmen's Schools at .......in the State of .............in accordance with the terms of my commission.

I certify that ..............duly commissioned by.........
has been transported from.....home in.......to.... .......where....is now employed as a teacher for....... at an actual cost for transportation-fares, procured at the lowest rates, and by the shortest practicable route at a cost of..........................dollars ($.....).100
.....................Agent.

I certify on honor that the above named.................is a teacher of ............in the State of.............

Approved and ordered paid}
.............................}Supt. Education State of.....
Asst. Commissioner.}

Received at.......this.....day of.................186.. of..........the sum of.......dollars and.............cents
in full of the above account.