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Form. 27.

The United States,
To Dr Geo St. C. Hussey Dr.

[[4 columned table]]
| 1867 |   | DOLLARS. | CTS. |
| --- | --- | --- | --- | 
| March 25 | For services as Acting Asst Surgeon from 8th December 1866 to 25 March 1867. In Freedmans Bureau 3 months & 17 days at $100 pr mo. The above services were rendered in accordance with an order received from Bvt Maj S. H. Horner Asst Surg. U.S.A. which is hereto attached. | $ 356 | 66⅔ | 

I certify that the above account is correct and just; that the services were rendered as stated; were necessary for the public service, and have been paid by me as charged.
Geo. St. C. Hussey, M.D.

Received, at St. Louis, Mo., this ... day of ... 186 from ... C.S.,    ... Dollars, and ... Cents, in full of the above account.

(SIGNED IN DUPLICATE.)
Geo. St.C. Hussey, M.D.

Note.——Period of service, rate of pay per day or month, nature of duty, &c., should be stated in this voucher.