http://www.loc.gov/mods/v3 http://www.loc.gov/standards/mods/v3/mods-3-2.xsd
pagó el real derecho del tributo [blank] casado veinte reales, perteneciente á el año de 180[blank], en 180[blank]=Juez
1 sheet (1 unnumbered page) : illustrations ; 31 x 22 cm.
Printed form (8 forms contained on sheet) with blank spaces for names of taxpayers and year when taxes were paid filled in in ms. Each copy of the form signed: Macsiel.