Front:
OFFICE OF J. G. RAY, SECRETARY TO HEAD CONSUL, M. W. OF A., LINCOLN, NEBR.
Back:
578
Form 4494-12-08-16 M.
OFFICIAL RECEIPT
FEB 17
Rock Island, Ill...
Received from the party to whom this
card is addressed, and passed to credit,
the following amounts:
Benefit assessment $
No...........
19 2-2014
1910
ONEUENT
NO. 18 M. W. OF A SF
Mr.
Per Capita
C.mille
589
abe Cameron
Supplies
Clerk of Camp No.
M. W. of A.
Certificate fees.
Total ...
State?
Province
Hlinois
entah
Head Clerk, M. W. of A.
This sories of 14 Hond Office views can be obtained for 20
conta. Bupply Dopartmont, M. W. of A., Rook Island, iu.