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NARA 965

Bu. R. F. and A. L.
Form 11.
The United States,
To Annie F. Clements Dr.

[[4 columned table]]
| 1868 |   | Dolls. | Cents. |
| --- | --- | --- | --- |
| October 31st | For rent of building occupied as office Bureau Refugees, Freedom, and Abandoned Land, at Macon State of Mississippi, from the 1st of October 1868, to the 31st of October, 1868, 31 days, at the rate of $25, per month. | 25 | 00 |
|   | Twenty Five Dollars | 25 | 00 |
[[/table]]

I certify, on honor, that the above account is correct and just; and that the building was used as stated; and that the same was necessary for the public service, and that is has been reported, as per my report of persons and articles, for the month of ........, 1868.

Approved and Payment Ordered:

.............
Brevet Major General U.S.A., Assistant Commissioner.

...............
Lieut. 24th U.S. Inf'y, Disbursing Officer and Act. Asst. Q.M.

Received at Vicksburg, Mississippi, the ......... of  ........ 1868, of Lieutenant J. W. Sunderland, 24th U.S. Infantry, 
Disbursing Officer, Bureau Refugees, Freedmen and Abandoned Lands, State of Mississippi, Twenty five dollars and - cents, in full of the above account.

(SIGNED IN DUPLICATE)
Annie F Clements

Transcription Notes:
---------- Reopened for Editing 2024-05-30 09:18:22