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|Teacher's Monthly School Report.|
|For the month of [line] May 1867.|
|District [or County, crossed out] of Colombia.|
|[State, crossed out] Washington D.C.|
|Name of School, First Col of School|
|Name of Teacher, Ms C. Hain|
|N.Y. Branchc J + W. Com.|
|Forwarded [line] 186.|
|Recieved [line] 186.|