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The undersigned destitute persons of Nottoway Co. Va. do hereby acknowledge to have received the amounts of Subsistence Stores set opposite our respective names.

[[18 columned table]]
| Date of Issue 1867 | Station | Name of Person or Head of Family | Commencing | Ending | Days No | No of Family Adults No | No of Family Children No | No of Family Total No | Class White No | Class Colored No | Pork Lbs | Herring Lbs | Corn Meal Lbs | Beans Lbs | Rye Coffee Lbs | Signature | Witness |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |

| Jan. 1 | Burkville Va | Silvay Smith | Jan. 1, 1867 | Jan 31, 1867 | 31 | 1 |   | 1 |   | 1 | 8 15/16 | 16 10/16 | 31 | 3 1/16 | 2 1/16 | Silvay Smith her x mark | Wm. H. Robertson |

| Jan. 1 | Burkville Va | Horace Jones | Jan. 1, 1867 | Jan 31, 1867 | 31 | 1 |   | 1 |   | 1 | 8 15/16 | 16 10/16 | 31 | 3 1/16 | 2 1/16 | Horace Jones. his x mark | Wm. H. Robertson |

| Jan. 1 | Burkville Va | Judy Robertson | Jan. 1, 1867 | Jan 31, 1867 | 31 | 1 |   | 1 |   | 1 | 8 15/16 | 16 10/16 | 31 | 3 1/16 | 2 1/16 | Judy Robertson. her x mark | Wm. H. Robertson |

| Jan. 1 | Burkville Va | Fanny Stokes | Jan. 1, 1867 | Jan 31, 1867 | 31 | 1 |   | 1 |   | 1 | 8 15/16 | 16 10/16 | 31 | 3 1/16 | 2 1/16 | Fanny Stokes. her x mark | Wm. H. Robertson |

| Jan. 1 | Burkville Va | Ceasar Eppes | Jan. 1, 1867 | Jan 31, 1867 | 31 | 1 |   | 1 |   | 1 | 8 15/16 | 16 10/16 | 31 | 3 1/16 | 2 1/16 | Cesear Epps. his x mark | Wm. H. Robertson |

| Jan. 1 | Burkville Va | Ruth Fulks | Jan. 1, 1867 | Jan 31, 1867 | 31 | 1 |   | 1 |   | 1 | 9 1/16 | 16 14/16 | 31 | 3 5/16 | 2 3/16 | Ruth Fulks. her x mark | Wm. H. Robertson |

|   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   |   | Wm. H. Robertson |

|   |   | Total |   |   |   | 6 |   | 6 |   | 6 | 53 1/2 | 100 | 186 | 18 1/2 | 12 1/2 |      |       |

I certify that the above return is correct and that the Stores were necessarily issued to prevent actual suffering

D.J. Connolly
Bv't Capt. & Asst Supt

Transcription Notes:
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