u. p. DepartuM 



Bureau i 



Grain Systei 



f^l^tloi Date ,19 Report No. 



St) 



Date. 



Tickets class 

 No. 



Gross. 



Dies. 



Net. 



Use this space for all Inlormation re- 

 garding the making or receiving of 

 notes and for explanation of all 

 other transactions. 



Drafts drawn and checks received. 



Commission accounts. 



Firm. Car No. Amount 



Date. 



Check 

 No. 



Kind. 



Consignment shipments and deliveries on contract. 



Date. 



Consignee. 



Car No. 



Kind, class, 

 and grade. 



Gross 

 Bu. 



Applied on 

 cont. of. 



Ticket Nojt sales Nos to. 



134432 



P. and S. Accoimts Nos to. 



