The receipt was used in the southern region of the Ukrainian People’s Republic occupied by White Russian military formations during the Russian-Ukrainian War (1917–1921). The document is dated October 10, 1919. It was issued in Odessa by the "Kherson Provincial Commissioner of Food Affairs under the Commander-in-Chief of the Armed Forces of South Russia"—a government body of the White Movement. The document confirmed the owner’s right to monetary compensation for grain seized under the grain duty law. Such documents functioned as temporary payment obligations of the state to the population during periods of extreme monetary instability, state collapse and banknote shortages. The actual payment under the receipts often depended on the subsequent military-political situation and was frequently never made.
The receipt is rectangular in shape, printed on yellowish paper with one-sided typography. Text in Russian. In the middle of the rectangular frame there are the name of the voucher and the issuer: "Temporary receipt for two hundred and fifty rubles. Kherson Provincial Authorized Food Department of the Commander-in-Chief of the Armed Forces of the South of Russia". Below there is the text with the signatures of the authorized department, the head of the department and the assistant accountant. The series and number, place and year of issue are indicated at the top, the denomination is indicated in the numbers "250" in the corners. On the left is the counterfoil (stub) featuring the corresponding number, series and the official seal of the Food Commissioner’s Department of the Kherson Province.