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No. 40.
SPECIAL REQUISITION.

[[3 columned table]]
|   | Form |   |
| --- | --- | --- |
| (40) forty Blanks | No 2 | Application & Receipt Rolls |
| (10) ten Blanks | No 2 | Report of Persons & Artcles hired |
| (40) forty Blanks | No 22 | Vouchers |
| (20) twenty Blanks | No 11 | Vouchers for Services rendered as Agt B.R. &c |
| (30) thirty Blanks | No 17 | Vouchers for expences incured for transportation |
| (10) ten Blanks | No 4 | Abstract for provisions issued |
| (10) ten Blanks | No 5 | Statement of provisions issued |
| (15) fifteen Blanks | No 15 | Monthly return of Stores Bureau &c |
| (10) ten Blanks | No 40 | Special requision |
| (6) six Blanks | No 3 | Requisition for Suplies, for distribution under Act of Congress Approved March 30/67 |
[[/table]]

[[stamp]] THE NATIONAL ARCHIVES OF THE UNITED STATES [[/stamp]] 

I Certify, That the above requisition is correct; and that the articles specified are absolutely requisite for the public service, rendered so by the following circumstances: For use of Bureau R F & A L Office Cartersville Cass County Geo,

C.B. Blacker, Agt Bureau &c

[[blank]] Quartermaster U.S Army, will issue the articles specified in the above requisition.

[[blank]] Commanding.

RECEIVED, at [[blank]] the [[blank]] of [[blank]] 186 of [[blank]] Quartermaster, U.S. Army [[blank]] in full of the above requisition. 

(SIGNED IN DUPLICATE.)
C. B. Blacker, Agt, Bureau, &c,

Transcription Notes:
&c = etcetera

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