Pre-printed form on crude CS paper originally for Richmond. Measures 5.5” x 3.75”. Dated October 1, 1863.

“Received of Wm. H. Preas Shff the following slaves, viz.: Varner sent from Bedford County by Stephen T. Petus, Esq. for work on fortifications at and near this city. By order of Col. W. H. Stevens, Chief Engineer, D.N.V.”

Signed by E.E. Mason, Lt. Engineers, Government Agent.  [ss]

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