Middx ss.

These are humbly to Certifie the Justices of the Peace
for the County of Middx in their Quarter Sessions
Assembled this Eighth day of October Ano. Dud
That the house of Henry Soursbey< no role > in [..]
in the Parish of St. Mary White Chappall is Appointed
and used as a place to Meet in by Protestant [..]
dissenting from the Church of England monly called [..] Anabaptists for Exercise of
Religions Worship Dated this Eighth day of October
Ano: Dni 1702 .

Moses Askell< no role >
Tho Gibbons< no role >
Jos: Mallory< no role >
Joseph Duston< no role > [..]