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NARA 734 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. 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. | | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | | 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 Jacson | 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 Rodford | Laundress | Aug 1"/66 | Aug 31"/66 | 10 | 00 | | | 10 | 00 | 10 | 00 | Eliza Rodford her x mark | Geo. S.H. Hussey Jr. | | 20 | Hilta Houston | Laundress | Aug 1"/66 | Aug 31"/66 | 10 | 00 | | | 10 | 00 | 10 | 00 | Hilta 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. | Approved D.M. White Lt. A.A.Q.M. I certify that the above Receipt Roll is correct and just, Geo. S.H. Hussey M.D. A.A. Surg. 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.