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I hereby certify that the foregoing account is accurate and just ; that I have not been absent without leave during
any part of the time charged for; that I have not received pay, nor drawn rations, forage, or clothing in kind, or re-
ceived money in lieu of any part thereof, for any part of the time therein charged; that I actually owned and kept in
service, the horses, and employed the private servants for which I charge, for the whole of the time charged; and that
I did not, during the term so charged, or any part thereof, keep or employ a soldier as a waiter or servant; that the
annexed is an accurate description of my servant; that, for the whole period charged for my staff appointment, I act-
ually and legally held the appointment, and did duty in the department; that I was the actual and only commanding
officer at the double-ration post charged for; and that no officer, within my knowledge, has a right to claim, or does
claim, for said services, for any part of the period charged; that for the whole time brevet pay is claimed, I had the
command stated; that I was actually in the command of a company for the whole time additional pay is charged;
that I have not been in the performance of any staff duty for which I claim, or have received, extra compensation
during the time an additional ration is charged for; that I have been in the United States Army as a commissioned
officer for the number of years stated in the charge for extra rations; that I am not in arrears with the United States
on any account whatsoever; and that the last payment I received was from Paymaster

and to the
of 18–.

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.

day

100

DESCRIPTION OF SERVANTS.

(Signed duplicates.)

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on the

Form No. 4.
Certificate to be given a soldier at the time of his discharge.
I CERTIFY that the within named

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

laundress at

dollars. The contract price of the ration at is

cents.

Given in duplicate at

this

day of

18%

Commanding Company.

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,

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For pay for traveling from the place of my

discharge, to the place of my residence,
-miles, at twenty miles per day, equal to
days, at dollars per month

days, at

For subsistence for traveling as above,

cents per ration or day....... For clothing not drawn .......

Amount.....

Deduct for Army Asylum...........
Deduct for clothing overdrawn........

Balance due..........

Received of

184,

Paymaster U. S. Army, this

day of dollars and cents, in full of the above

account.

(Signed in duplicate.)

Pay......
Subsistence......
Clothing

Dollars......

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I do hereby certify that the foregoing Abstract contains an accurate

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Remarks.

Dolls. Cts. Dolls. Cts. Dolls. Cts. Dolls. Cts. Dolls. Cts. Dolls. Cts.

statement of the payments made by me, as therein expressed.

Paymaster.

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