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NARA 740

FORM 7.

WE, THE SUBSCRIBERS, do hereby acknowledge to have received, at Lauderdale, Miss., of Capt. C. R. Tyler, A.Q.M., U.S. Vols., Receiving and Disbursing Officer,
Freedmen's Bureau, State of Mississippi, the sums set opposite our names, being in full of our services for the time herein expresses, 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. | Geo. S.H. Hussey, Jr. | Steward. | Sept. 1st/66 | Sept. 30th/66. | 40. | 00. | 40. | 00. | — | — | 40. | 00. | George, S.H. Hussey Jr. | Geo. S.H. Hussey Jr. |

| 1. | George, Washington. | Ward Matron, | Sept. 1, 1866. | Sept. 30, 1866. | 15. | 00. | 15. | 00. | — | — | 15. | 00. | Geo. Washington. his X Mark | Geo. S.H Hussey Jr. |  

| 1. | Mary, Howard. | Matron, | Sept. 1, 1866. | Sept. 30, 1866 | 18. | 00. | 18. | 00. | — | — | 18. | 00. | Mary Howard her X Mark | Geo. S.H. Hussey Jr. |

| 1. | Simon, Taylor, | Nurse, | April. 1, 1866. | Sept 15. 1866 | 10. | 00. | 5. | 00. | — | — | 5. | 00. | Simon Taylor, his X Mark "by his account & his request. by, Lt. C. Hussey Jr. | Geo. S.H. Hussey Jr. |

| 1. | Jamima, Peters. | Nurse, | June 18, 1866. | Sept 18, 1866| 10. | 00. | 6. | 00. | — | — | 6. | 00. | Jamima Peters. his X Mark | Geo. S.H. Hussey Jr. |

| 1. | Jamima, Ricks. | Nurse, | Sept. 1, 1866 | Sept. 30, 1866. | 10. | 00. | 10. | 00. | — | — | 10. | 00. | Jamima Ricks his X Mark | Geo. S.H. Hussey Jr. |

| 1. | Mary, Lockwood, | Nurse, | Sept. 1, 1866 | Sept. 14, 1866 | 10. | 00. | 4. | 66 2/3. | — | — | 4. | 66 2/3. | [[?] her daughter Mary Lockwood her X Mark | Geo. S.H. Hussey Jr. |

| 1 | John Culican | Nurse | Sept 1, 1866 | Sept 14 1866 | 10 | 00 | 10 | 00 |   |   | John Culican his x mark | Geo. S.H. Hussey Jr. |

| 1 | Elisebeth Raines | Cook | May 15 1866 | Sept. 14, 1866 | 10 | 00 | 10 | 00 |    |   | 10 | 00 | Elisebeth Raines her x mark | Geo. S.H. Hussey Jr. |

| 1 | Sally Killingsworth | Laundress | May 1 1866 | Sept 14 1866 | 10 | 00 | 10 | 00 |   |   | 10 | 00 | Sally Killingsworth her x mark | Geo. S.W. Hussey Jr. |

| 1 | Hettie Houston | Laundress | June 16 1866 | Sept 14 1866 | 10 | 00 | 10 | 00 |   |   | 10 | 00 | Hettie Houston her x mark | Geo. S.H. Hussey Jr. |

| 1 | Carolina Battle | Laundress | Aug 1 1866 | Sept 25 1866 | 10 | 00 | 8. | 33 1/3 |   |   | 8 | 33 1/3 | Carolina Battle her x mark | Geo. S.H. Hussey Jr. |

| 1 | Dick Battle | Cook | Sept 10/66| Sept 30 1866 | 10 | 00 | 6. | 66 2/3 |   |   | 6. | 66 2/3 | Dick Battle his x mark | Geo. S.H. Hussey Jr. |

| 1 | Parker Mathery | Nurse | Sept 1/66| Sept 30 1866 | 10 | 00 | 10 | 00 |   |   | 10 | 00 | Parker Matherly his x mark | Geo. S.H. Hussey Jr. |

| 1 | Fanny Mathey | Cook | Sept 1/66 | Sept 30 1866 | 10 | 00 | 10 | 00 |   |   | Fanny Mathery her x mark | Geo. S.H. Hussey Jr. |
| 1 | Marie Legart | Laundress | Sept 1/66 | Sept 30 1866 | 10 | 00 | 10 | 00 |   |   | 10 | 00 | Maie Legart her x mark | Geo. S.H. Hussey Jr. |

| 1 | Hariet Finley | Cook | Sept 1/66 | Sept 30 1866 | 10 | 00 | 10 | 00 |   |   | 10 | 00 | Hariet Finley her x mark | Geo. S.H. Hussey Jr. |

I certify that the above Receipt Roll is correct.
Geo. S.H. Hussy MD
A.A. Surg, Howard Hospital
Lauderdale, Miss.

Approved and payment ordered.
Assistant Commissioner, State of Mississippi.

Transcription Notes:
apologies if [[his/her mark, x]] is not great formatting for the transcriptions; please change if needed 4/2 - per instructions 'his/her X Mark' is to be transcribed after the full name, this is not fully transcribed - pls complete