✨ Financial Receipt Form
FORM H.
THE PROVINCIAL GOVERNMENT OF OTAGO,
Dr. to
| Period of Service, 186 | Head, as per Appropriation Act— | Year 186 | Rate. | Amount. |
|---|---|---|---|---|
| Div. No. | Subdiv. No. | |||
| Item: | ||||
| Full Particulars. |
Total, | pound | shilling | pence |
Signature of Claimant
I certify to the best of my knowledge and belief, after due enquiry, that the foregoing account is true and correct in every particular, and that this expenditure has been incurred under authority of *
Signature of the Officer by whom the expenditure was incurred
Signature of the Head of the Department
Date | 16
- State number and description of authority;
Received on the ___ 186, from Esquire, Provincial Treasurer, the sum of __ pound __ shilling __ pence, in full payment of the above account.
Witness to the payment and signature—
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Otago Provincial Gazette 1863, No 277
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Provincial Treasurer Receipt Form
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💰 Finance & RevenueReceipt, Provincial Treasurer, Financial Transactions, Otago