OnN'KRAI. ACCOUNTING OFFICE. 
fiiA'i'K and Othbji Departments Division. 
Form 5005. 
MISCELLANEOUS FISCAL OFFICERS CERTIFICATE NO. 
GENERAL ACCOUNTING OFFICE, 
STATE AND OTHER DEPARTMENTS DIVISION. 
STATEMENT OF ACCOUNT AND CERTIFICATE OF SETTLEMENT. 
In account current with the United States under bond dated 
PERIOD 
DEBITS. 
Balance due the United States per Certificate No. !0S' y 8 
Accountable warrants: 
TOTAL. 
CREDITS. 
TREASURY deposits. 
Hieo. Repay Vt. 82/67911, Sept* 30, 1921 
I 
ft 9 b- 
- — . p\ - 
GENERAL ACCOUNTING OFFICE, STATE AND OTHER DEPARTMENTS DIVISION. 
Washington, D. C., .. 
19 
’ r» p* 
C O 
Jah.UO, 
SI as . Fa tniore » "empcr^ry Spa dial Disburs' 
, with the United States, from , 19 
xjyixxSupplemanfc al 
to 1 »F lOPc^S — 19 , under his official bond dated 19... and find balance due the 
1 certify that I have examined and settled the account of 
4n^ A g x. n t, Dep» t * of Agrloul-tur®---- 
April 28, 
20 
United States. dollars, as stated above. 
Nf “ 
sue the reverse hereof 
Please cause to issue 
XXxxxxxxxxxxxxxxxxxx 
XXX xxxxxxx XX xxxx 
J. R. McCARL, 
To the Secretary of the Treasury 
(Division of Bookkeeping and Warrants). 
— 085 H 
