McCulloh9
e. FORM NO. L . IIXATG NO.044 R .
Estimate and Assessment of AGRICUUMR. L PRODUCTS which are taxed in kind,. ttgrsea upon by that
Aspessor And.7.'.ax Payer, and. the value of -the portiom'thereof to which the GOTarxmeut is entitled, in:
�* accordance with the provisions of "Aa Act to lay taies for the conigon defence, and, carr Olt.th2.
Government of the 'Confederate States," and . aR "Act .to amend said Act, approved' 17th of FakUMT,
1864 ;" said; Fatimate and Astreasment :to be retxrne'd to the District QaartermoAter os or before the lot
,}lay of Soptpmlier of each year.
♦Gxlcv,LTUXAL •YRI/He OTS-1_QUANTITY OF SMOSS'Cnors;
:;1mALVrV
WAIVIVE I-.VALYaCj)*IF TITHE
WHEAT..,.............................M
sC,t
OA'1'9'
SHE O QTS. l • • ..
•..4.•••• •• •-IIS
t
CURED HAY ..........................
woof..
f,
6C®lt®
Received
Z
Dastricti,
State of
s
4+
- Bushels _
Iounds of' Whewty
-,
`Bushels_
I'
Potnds of Oata,
Pounds of
nn
L�
11 II
#:_
_ - TBtad Rcluu $i
of Cured I3ay, 1
Pouudq__Unnces
1-y/Ll'�Na- of the � eC and stato'.
O L do swear that the abeVa is a true Statement sad etthR%to of all the A;rioulmral Preduate aboVo
,_named produced by me du(iag lho year. l^8%r .which are taxable by the prortatem of tha above Stale4 Act-, lncludiug wbat may bave'been told
or consumed Ly meis t tho bawl of, my Icnnwlodge and belief t _ �— -
TA: stPs:stt.
y f
Sworn to and tiiscribid byfare me, the a �' �19t1k- . ani I furfJur certify
that the sieve Estimate and Assessment has igen agreed upon,by said
- _ _and ssyself, as a
correct attd true statementof the amount of his crops, aqd that the value of t� portion to which the, Government is entitled is corresdy stated.
.' r •�" Att Esso R,
_Tax District, 'State of • �j' r (. if 71 i
6C®lt®
Received
at Depot No ;'_TTCougreesio�tal
Dastricti,
State of
s
of
4+
- Bushels _
Iounds of' Whewty
-,
`Bushels_
Potnds of Oata,
Pounds of
Pounds
of Cured I3ay, 1
Pouudq__Unnces
of Wool,
.r.. .,
:--''L
of the above estimate.
I
-
a e ✓
IRP
OAVIE C0: PUBLIC LLIBRAPy.
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MOCKSAIE, NG