"Proof of payment for transfer tax overgangbelasting 1955, for staff members for the month December 1955 for the amount of $ 15.00 [13 Jan 1959]"

Printed form filled in by using typewriter, with signatures in different colours. There is a seal of the secretary of N.V. SITEM Dabo Singkep and of the post office Dabo Singkep.