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Confederate States of America, to Mr. [blank], Dr. : For amount of pay as a member of Congress from the state of [blank], from [blank] day of [blank], A.D., 1862, to the [blank] day of [blank], A.D. 1862, inclusive, at $230 per month $[blank]. And mileage, at twenty cents per mile by the usual route of travel, from his residence to the place of assembling of Congress, Total [blank] $[blank] $[blank]. Examined and approved [blank][blank] Chairman of Committee on Pay and Mileage.

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