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[ED. FORM, NO. 3.]

TEACHER'S MONTHLY
SCHOOL REPORT
For the month of January, 1870
District or County, Dallas County
State, of Alabama
Name of School, No 3 Township 16 R 9
Name of Teacher, John W. Smyth

Approved and resptfully refered to you with the hope that it will be paid
J H Sears
Supt. of Dallas County

Forwarded
Received