Form 1.

Received, at Memphis [?] this ____ day of October 1864, of __ the following amount of Funds, on account of the Freedmen Department:

         AMOUNT.           DOLLARS. CENTS.                                        REMARKS.

Four hundred dollars 400, 00 Being [account?] of friends received from sale of wood

                                                                          cut by Freed[men?]
                                             $ 400 00

[Jno.] F. Perry. 1st [Y?] and [Adifl?] 63 a/11 A. B. C. D. and [?] Freed[men?] Dept