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NARA 746

Form 7

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

|   | Geo. S. H. Husssey, Jr. | Seward, | Sept. 1, 1866 | Oct. 31, 1866, | 40. | 00. | 40. | 00. | ~ | ~ | 40. | 00. | Geo. S. H. Hussey Jr. | Geo. S. H. Hussey Jr. |  
|   | Geo. Washington - | Nurse. | Sept. 1, 1866 | Oct. 31, 1866, | 10. | 00. | 10. | 00. | ~ | ~ | 100. | 00. | Geo. Washington his X Mark | Geo. S. H. Hussey Jr. |    
|   | John. Culijan. | Nurse. | Aug. 1, 1866 | Oct. 31, 1866. | 10. | 00 | 10. | 00. | ~ | ~ | 100. | 00. | John Culijan his X Mark | Geo. S. H. Hussey Jr. |  
|   | Jamina Ricks, | Nurse. | Aug. 1, 1866 | Oct. 31, 1866. | 10. | 00 | 10. | 00. | ~ | ~ | 100. | 00. | Jamina Ricks her X Mark | Geo. S. H. Hussey Jr. |   
|   | Parker, Mathany, | Nurse. | Sept. 1, 1866 | Oct. 31, 1866, | 10. | 00. | 10. | 00. | ~ | ~ | 100. | 00. | Parker Matheny, his X Mark | Geo. S. H. Hussey Jr. |    
|   | Eliza, Cockeral, | Nurse. | Oct. 1. 1866 | Oct. 31, 1866, | 10. | 00. | 10. | 00. | ~ | ~ | 100. | 00. | Eliza Cockeral her X Mark. | Geo. S. H. Hussey Jr. | 
|   | Elizabeth Raines | Cook. | May, 15, 1866 | Oct. 31, 1866, | 10. | 00. | 10. | 00. | ~ | ~ | 100. | 00. | 10. | 00. | ~ | ~ | 100. | 00. | Elizabeth Raines her X Mark | Geo. S. H. Hussey Jr. |  
|   | Fanny, Matheny, | Cook. | Sept. 1. 1866 | Oct. 31, 1866, | 10. | 00. | 10. | 00. | ~ | ~ | 100. | 00. | Fanny Matheney her X mark | Geo. S. H. Hussey Jr. |  
|   | Harriet, Finley, | Cook. | Sept. 1. 1866 | Oct. 31, 1866, | 10. | 00. | 10. | 00. | ~ | ~ | 10. | 00. | Harriet Finley her X Mark | Geo. S. H. Hussey Jr. | 
|   | Dick, Battes, | Cook. | Sept. 10, 1866 | Oct. 31, 1866, | 10. | 00. | 10. | 00. | ~ | ~ | 10. | 00. | Dick Battes, his X Mark | Geo. S. H. Hussey Jr. | 
|   | Sally, Killingsworth. | Laundress. | May 1, 1866 | Oct. 31, 1866, | 10. | 00. | 10. | 00. | ~ | ~ | 10. | 00. | Sally Killingsworth her X Mark | Geo. S. H. Hussey Jr. | 
|   | Hattie Houston | Laundress. | June 18, 1866 | Oct. 31, 1866, | 10. | 00. | 10. | 00. | ~ | ~ | 10. | 00. | Hattie Houston, her X Mark | Geo. S. H. Hussey Jr. |  
|   | Marie, Segars. | Laundress. | Sept. 1. 1866 | Oct. 31, 1866, | 10. | 00. |  10. | 00. | ~ | ~ | 10. | 00. | Marie Segars, her X Mark | Geo. S. H. Hussey Jr. | 
|   | Sally, Thompson, | Laundress. | Oct. 1. 1866 | Oct. 31, 1866, | 10. | 00. | 10. | 00. | ~ | ~ | 10. | 00. | Sally Thompson, her X Mark | Geo. S. H. Hussey Jr. |

I certify that the above Receipt Roll is Correct.
Geo. H. C. Hussey M.D.
A.A. Surg. in Chrge H. Hospt.
Lauderdale Miss,

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

Transcription Notes:
Per instructions 'his/her X mark' is to be inscribed after the full name 4/3 - fully transcribed, pls review