Printed form filled out in ink.  Measures 13” x 5 ½”.  Dated November 27, 1864.  This particular form accounts for the 72 prisoners in Block 5.  Filled out by a Sergeant of the 5^th Veteran Reserve Corps.  A Lt. R.C. Jones of the 5^th Alabama Infantry is noted on the back of form for an unknown reason.   [jet]

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