J

Do Solomnly Sincerely & truly declare & Affirm that Sam a freeholder Etc

You shall Swear that you are a Freeholder in the County of Middlesex & have a freehold
Estate Consisting of Messuages Laudd or Tythe in the Occupation of

You shall Swear that you are a freeholder in the County of Middlesex & have a freehold
consisting of Rent or Rents [..] fsuing or Laudd or Tenemented or Some or One of them
of which [..] or Owner or is in the Possession of

lying or being at [..] withe county of Middlesex of the Clear Yearly [..]
Value of [..] over and above all rents and Charged payable out of or in
respect [..] and that you have been in the Actual Possession or receipt of
thereto [..] there of for your own Use above Twelve [..] Kalandar Months or
that the same [..] you within the time aforesaid by Decout Marriage Marriage
Settle [..] motion to a Benefice in a Church or by promotion to an Office
and [..] at [..] Estate has not been Pranted or made to you [..] Frandulently on
purpose to [..] you to give your [..] and that the place or your abode is at
And that you are Twenty One Years of Age
as you beleive [..] not been polled before at this Election
[..] Shipgood

J do Actualy Affeirm

J so Swear I have not received or had by myself or any person
whatsoever Twist for me or for my Use and benefit directly or Indirectly any
Sum or Sume of money Office place or Employment Gift or reward or any promise
or Securts for any money Office Employmentor Gift in order orto give my vote at
this Eleita

So help