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

The humble Peticon & Appeal of
Tobias Gibson< no role > of the Parish of St.
James Clerkenwell in the said
County.

Sheweth

That your Peticoner is rated for the Sum of Two
hundred Pounds Stock or Personall Estate in
the poor rate of the said Parish

That your Peticoner hath not any Stock or
Personall rate in the said Parish & Appeal
against the said rate

Yor Petitr: therefore humbly prays
this Court will be pleased to appoint a
Day this Sessions for the Churchwardens
& Overseers to attend to shew cause
why yor Petitr should not be
Discharge from the aforesd Assessmt.

And Yor Petr. Shall Ever pray Etc

T: Gibson