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Bureau of Refugees, Freedmen, and Abandoned Lands. The United States, To .............. Dr. [[4 Columned Table]] | 18 | | Dolls. | Cts. | | --- | --- | --- | --- | | Washington, D.C. | For rent of _________ at __________ County ________ , occupied as a Freedmen's School from ________ , 18 , to _________ , 18 , inclusive, being ____ month _____ days, at ______ dollars a month. | | | | | /100 Dollars, | | | [[stamp]] THE NATIONAL ARCHIVES OF THE UNITED STATES [[/stamp]] I CERTIFY, ON HONOR, that the above account is correct and just; that the building was occupied as stated, and was necessary for the public service. ________________________ Supt. Education, State of Approved and ordered paid. __________________________________________________ Bvt. Maj.-Gen., Commissioner of Refugees, Freedmen &c. Received, at Washington, D.C., this ____ day of ___ 18__ , from Bvt. Brig.-Gen. GEORGE W. BALLOCH, Chief Disbursing Officer,___________ dollars and ____ cents, in full of the above account, by Check No._____ on _____, dated 18__ . [SIGNED IN DUPLICATE.] F. A. M. Shaver