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[pre-printed check form]
Exchange for California $272.00 Banking House
Of Donohoe, Ralston & Co. San Francisco Jany 9th 1863
Pay this DUPLICATE of Exchange (original unpaid) to the order of Mrs. C. C. Auger Two Hundred and Seventy two 00/100 dollars Value received and place to account of Mefs. Eugene kelly & Co.
To the Park Bank New York City [signature] D. M. Wood Ralston ? No. 4790