Form 4 to. 
USE ONE SIDE ONLY. 
Approved by the Comptroller of 
the Treasury May 28 , 1914 . 
Subvoucher for Supplies, Livery and Miscellaneous Services, 
and Expenses. 
Address : 
, 191 . 
For 
-O C/vL C 
/ 
oL 
/ __ 
3 ^ 
: 
1 
Total, $ 
-s^= 
Efemr. 
TO BE COMPLETELY FILLED IN BEFORE SIGNATURE BY PAYEE, AND THERE 
MUST NOT BEANY ERASURE OR OTHER ALTERATION WHATEVER, 
rj tife 
Received in Cask this / day of 
Dollars, in full 
of the above account, which I 
Do not sign in 
-^fui 
Witness to signature by mark. 
100 
TO BE CORRECT. 
if 
(Name.) 
S 2707 
CAddress. ) 
