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Bureau of Refugees, Freedmen, and Abandoned Lands.

THE UNITED STATES,

To ............. Dr.
[[4 Columned Table]]
| 18 |   | Dolls. | Cts. | 
| --- | --- | --- | --- |

|   | 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, |   |   | 

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 .

Tho's J. Stevens

[Signed in Duplicate.]