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Office Supt. Refugees &c. 9th Dist. 
Fort Monroe, Va. January 28th

Col. O. Brown.
Asst. Com Freedmen's Bureau, State of Va.
Richmond, Va.

Colonel,
I have the honor to request Twenty copies Blank Land Report Forms.

I am, Colonel,
Very respectfully
your obedient servant
C.B. Wilder
Capt. and A.Q.M. and Supt.
9th Dist. Va.