To the Rt Worsppll his Maties Justices of the Peace for the County of Middx

The humble peticon and Appeale of other Richard Soud< no role >
of the Parish of St James Clerkenwell
in the said County

Sheweth

That your Petitr is rated two Shillings and Three Pence p
Month towards the relief of the Poor of the said Peticoner

That your Petitr: is a poor manWomanand [..] able to pay
the said rate

Therefore humbly prays such a Mittigation
thereof as onto your Worspps Shall
Seem Meete

And Yor: Petitr shall ever pray Etc

Alice Bond< no role >