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NARA 728

Form 7.

We, the subscribers, do hereby acknowledge to have received, at  of  , the sums set opposite our names, being in full of our services 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 Dollars. | Rate of Pay. Cents. | Stoppage. Dollars. | Stoppage. Cents. | Total Am't Due. Dollars. | Total Am't Due. Cents | Amount Rec'd. Dollars. | Amount Rec'd. Cents. | Signatures. | Witness |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | 
| 14 | Charles Perry | Nurse  | Aug 1 /66 | Aug 31 /66 | 10.00 |   |   |   | 10.00 | 10.00 | Charles Perry his X Mark | Geo. S. H. Hussey Jr. |
| 15 | Emma Jackson | Cook | Aug 1 /66 | Aug 31 /66 | 10.00 |    |   | 10.00 | 10.00 | Emma Jackson her X Mark | Geo. S. H. Hussey Jr. |
|  16 | Sally Lloyd | Cook | Aug 1 /66 | Aug 31 /66 | 10.00 |   |   | 10.00 | 10.00 | Sally Lloyd her X Mark | Geo. S. H. Hussey Jr.  |
| 17 | Elizabeth Rains | Cook | Aug 1 /66 | Aug 31 /66 | 10.00 |      |   | 10.00 | 10.00 | Elizabeth Rains her X Mark | Geo. S. H. Hussey Jr.  |
| 18 | Sally Killingsworth | Laundress | Aug 1 /66 | Aug 31 /66 | 10.00 |   |   | 10.00 | 10.00 | Sally Killingsworth her X Mark | Geo. S. H. Hussey Jr. |
| 19  | Eliza Radford | Laundress | Aug 1 /66 | Aug 31 /66 | 10.00 |   |   | 10.00 | 10.00 | Eliza Laundress her X Mark | Geo. S. H. Hussey Jr. |
| 20 | Hittie Houston | Laundress | Aug 1 /66 | Aug 31 /66 | 10.00 |   |   | 10.00 | 10.00 | Hittie Houston her X Mark | Geo. S. H. Hussey Jr. |
| 21  | Caroline Battle | Laundress | Aug 1 /66 | Aug 31 /66 | 10.00 |   |   | 10.00 | 10.00 | Caroline Battle her X Mark | Geo. S. H. Hussey Jr. |

I certify that the above Receipt Roll is correct and just,
Geo. S. H. Hussey M.D.
A.A. Surg USA in charge Howard Hospital
Approved and payment ordered,
[[strikethrough]] Col. 64th U.S.C.I., [[/strikethrough]]
Ass't Commissioner Freedmen's Bureau, State of Miss.

Approved D. M. White 
Lieut A.A.Q.M.

Transcription Notes:
---------- Reopened for Editing 2024-04-03 09:54:35 There are 15 columns, table format incorrect, now corrected, pls read instructions, 'his/her X Mark' is to be transcribed after the full name per instructions, other corrections, removed excess spaces ---------- Reopened for Editing 2024-04-03 10:40:58