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NARA 332

FORM 7.

WE THE SUBSCRIBERS, do hereby acknowledge to have received, at [[blank]], of [[blank]], Receiving and Disbursing Officer, Freedmen's Bureau, State of Mississippi, the sums set opposite our names, being in full of our service for the time herein expressed, having signed duplicates hereof.

[[15 columned table]]
| No. | Names. | Occupation. | Period of Service. From- | Period of Service. To- | Rate of Pay. Dolls.|Rate of Pay. Cents.| Total Amount Due. Dolls.| Total Amount Due. Cents.| Stoppage. Dolls. | Stoppage. Cents. | Amount Received. Dolls. | Amount Received. Cents. | Signatures. | Witness. |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |

| 1 | James H. Pierce | Clerk | June 1 1867 | June 30 1867 | 100 | 00 | 100 | 00 |  | 83 | 99 | 17 | James H. Pierce | J Deemer |

|   |   |   |   |   |   |   |   |   |   |   | 99 | 17 |   |   |

APPROVED, and Payment ordered:     I CERTIFY, that the above receipt roll is correct

Bvt Maj Genl U.S.A. Assistant Commissioner, State of Mississippi.

Jas W. Sunderland
Capt V.R.C. Sub Asst Commr.

Transcription Notes:
[[?]] don't know what it is (Bvt Maj Genl U.S.A.)