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NARA 748

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. | 
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
I certify that the above Receipt Roll is collect. 
Approved and payment ordered: [[??]]
Assistant Commissioner, State of Mississippi. 

Transcription Notes:
All the columns are not filled.