To the Worshipfull her Majesties
Justices of the peace for ye County
of Middx

The Humble Peticon
of Robt: Champ< no role >

Sheweth

That yor. Peticoner being an Inhabitant
of the parish of St. Giles Cripplegate
without is assesed To the Poores Rate att
9s:10d: Eli which by reason of great Losses
and other Disapointments in Trade he iss
uncapable to pay but the officers threatning
[..] distrain of his Pdads for ye same

Yor peticonr Theirfore humbly
pray that he may be releived
as you in yor. greate Wisdom
shall Think. fitt

and yor peticonr: shall
Evr. pray