Dated Dec. 6th, 1864. Pre-printed lined form 19, measuring 8.5 x 11". The Confederate States, to: Robert W. Hines (in ink), 20 barrels of corn at $5 a bushel--$500; 17 bushels of peas at $7.50 a bushel--$127.50; total $627.50. Unsigned by receiving officer ("A.C.S., C.S.A.")in lower part of the form. Form somewhat yellowed, ink faded but legible. Light chipping along the bottom edge. Else VG. [jp] [ph:L]

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