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I hereby certify that the foregoing account is accurate and just ; that I have not been absent without leave during
and to the
I at the same time acknowledge that I have received of - , Paymaster, this day of —, 18—, the sum of
dollars, being the amount in full of said account.
DESCRIPTION OF SERVANTS.
Form No. 4.
of Captain company (-) of the
regiment of born in in the State of , aged - years,
feet inches high, complexion, eyes, hair, and by profession was enlisted by
- day of eighteen hundred and - to serve for years, and is now entitled to a discharge by reason of The said - was last paid by Paymaster
; to include the day of eighteen hundred and
and has pay due from that time to the present date.
There is due to him dollars retained pay.
There is due to him dollars on account of clothing not drawn in kind.
He is indebted to the United States dollars, on account of extra clothing, &c. He is indebted to
dollars. The contract price of the ration at is
Given in duplicate at
NOTE. -When a soldier transfers his certificates, the transfer must be ade on them, witnessed by a commissioned officer, when practicable, or by some other reputable person known to the Paymaster,
For pay for traveling from the place of my
discharge, to the place of my residence,
For subsistence for traveling as above,
cents per ration or day....... For clothing not drawn .......
Deduct for Army Asylum...........
Paymaster U. S. Army, this
day of dollars and cents, in full of the above
(Signed in duplicate.)