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�[this is a form with stamped and handwritten notation]

VOUCHER No. 12 [stamped] MEMORANDUM [double line]

Ledger No. 18 Page 38 [vertical line] APPROPRIATION: War Purposes [double line]

In Favor of O'Brien, Catherine Waterville. DATE Dec. 16 1918, AMT. $5.20 [double line]

CLASSIFICATION OF CLAIM

[three columns: items and then:] Dollars Cents

Laundry 2 [Dollars] 50 [Cents] Dinner (for two) 2 [Dollars] 70 [Cents]

On account of Halifax relief

Approved for 5 [Dollars] 20 [Cents] [double line] Received A.G. O. Jan. 15, 1918. Filed with Auditor FEB 25 1918 [stamped] Paid [line] Check No. [line] Deduct for [line]

4-20-17-1000