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Accounts for such transportation will be paid on the order of the Commissioner, and will be made up in the following form:
THE UNITED STATES,
To           Dr.
[[4 columned table]]
|Date.|   | Dolls.| Cts.|
|---|---|---|---|
|   | For cost of transportation at Government rates from ___ to ___, as per annexed statement. |   |   |
[[\4 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, and that it was impracticable to avail myself of the transportation orders issued on my behalf for the reason that _____ _____ _____, and that I paid the cost of my transportation between the points named above.
A____ B____, Teacher.

I certify that A.B., duly commissioned as a teacher in Freedmen's Schools, by ____ _____, has been transported from _____ home in ______ to ______, where _____ is now employed as such teacher.
C____ D____, Agent.

I certify, on honor, that the above-named A.B. is a teacher of Freedmen's Schools employed by _____, in the State of _____. 
_____________________
Supt Education, State of _____

Approved and ordered paid.
____________________
Commissioner.
Received at ______ this _____ day of ____, 186 , of _________, the sum of _______ dollars and _____ cents, in full of the above account.

Hereafter the cost of transportation will not be refunded except in cases where application for transportation shall have been made as above contemplated, nor under any circumstances will return transportation be furnished or the cost thereof refunded by this Bureau.
O.O. HOWARD,
Major-General, Commissioner.
OFFICIAL:
D.H. Williams
[[strikethrough]] Bvt. Brig. Gen., C.Q.M., Bu. R., F., & A.L. [[/strikethrough]]
1st Lt 4, Asst aaag