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NARA 744

Form 7

We, the subscribers, do hereby acknowledge to have received, at   Lauderdale Mississippi 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 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. | 
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |

I certify that the above Receipt Rall is correct. 
Approved and payment ordered: 
______________
Assistant Commissioner, State of Mississippi. 
Geo. St. C. Hussey
Act. Asst. Surg How'd Hospt
Lauderdale, Miss

Transcription Notes:
Partially transcribed - middle part missing columns.