The above receipt is a recent eBay purchase.
So far, neither Roger Burdette, Michael Fey nor Leroy Van Allan have ever seen an example of this receipt.
My speculation is that because silver dollars were used to secure silver certificates that the Treasury had a special interest in knowing how many silver dollars were in storage, so they created a special form for bankers and others to request them from sub-treasuries.
Perhaps one of the E-Sylum's subscribers can shed some light on it?
Interesting. I've never seen one of these, either. I like the N.O.L.A. abbreviation for New Orleans, Louisiana. Can anyone help?