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[[stamp]] Two U.S. Internal Rev. TWO (2) CENTS stamp initialed and dated [[/stamp]]
$30 00/100 Montgomery July 13th 1867
[[stamp]] The National Archives of the United States[[/stamp]]
On the 5th August next Pay to the 
Order of Joseph & Forp  
Thirty 00/100 Dollars
Value received and charge the same to account of 
To C.W. Buckley

C.C. Dickinson