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

18-.

I at the same time acknowledge that I have received of · dollars, being the amount in full of said account.

100

Paymaster, this

day of

day

18-, the sum

Form No. 4.

Certificate to be given a soldier at the time of his discharge.

I CERTIFY that the within named

a

of Cap

NOTE.-When a soldier transfers his certificates, the transfer must be made on them, witnessed by a commissioned officer, when practicable, or by some other reputable person known to the Paymaster.

the place of my

the place of my residence, miles, at twenty miles per day, equal to

discharge, to

I do hereby certify that the foregoing Abstract contains an accurate

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

Paymaster.