To the Right Worpll: her Maties. Justices of the peace
for the County of Middx

The humble. Peticon & appeale of John
Smith< no role > of the parish of St Giles
without Cripplegat in the St. County
Weaver

Sheweth

That yor Petr is rated 2s.6d. per Quarter towards the
releif of the poore of the St parish hath a wife
& 2d Children to maintane and yor Petr
is a weabe & Sickly man & a Small Trade
and hath not Whare with to pay the sd rate
by reason of said poverty

Therefore humbly prayes yor Worps
to be discharged from paying
the sd Assement

And yor Petr shall pray Etc

John Smith< no role >