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I certify that the prices of the articles above charged, for the use of the sick at requisition, are reasonable and just.

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Received,

18- of

dollars and

- cents, in full of the above account.

A. B.

Note.-The above certificate may be signed by the Surgeon making the requisition, or by any Surgeon or Assistant Surgeon belonging to the

army.

ARTICLES, AND CHARACTERS OR QUANTITIES.

Form 4.

RETURN OF MEDICINES, HOSPITAL STORES, FURNITURE, &C.

On hand at last return.

Received since last return.

Total.

Expended with the sick.

Issued.

Lost or destroyed by unavoidable accident.

Worn out, or unfit for use.

Total expended, &c.

On hand.

REMARKS.

Form 5.

ACCOUNT OF HOSPITAL STORES, FURNITURE, &c, ISSUED.

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Form 6.

ACCOUNT OF CLOTHING, ARMS, EQUIPMENTS, &c., OF PATIENTS IN HOSPITAL.

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No. of ward or kitchen.

Bunks.

Bed sacks.

Sheets.

Blankets.

Kettles.

Spoons.

Knives.

Forks.

&c.

&c.

Form 7. ACCOUNT OF FURNITURE, COOKING UTENSILS, BEDDING, &c., IN USE.

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