MilColl_WWI_82_Box2_060

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Status: Needs Review

Q. M. C. Form 51.

QUARTERMASTER CORPS, U. S. ARMY,

December 24, 1917
Received of Robt. B. House 2nd LT 103RD M. G. co.
Forty - Dollars and Twenty Cents,
being on account of Wa[?r?]Rick Insurance Premium
on 10,000 for 6 m[?ro?]. Aza 26
which sum I have passed to the credit of the United States, and hold myself accountable therefor.

$40.70 = [?VV?]9.10 FRANCS

Charles E. Sc[?arem?]
Quartermaster, U. S. Army.

[Text in left margin]TRIPLICATE
To be retained by the Officer in whose favor the
receipt is issued. [Text end]

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