J
8. G2 p.492

I do Solewuly Sincerely and truly Declared Affirm that I am a Fricholder Etc.

You shall Swear that you are a Freeholder in the County of Middx and have a Free
hold Estate, consisting of [Messuages, [..] nds or Tythw in the Occupation of

You shall Swear that You are a Free ho [..] der in the County of Middx and have a Freehold
Estate, consisting of [a Rent or Rents if s [..] ing out of Sm [..] or Ten [..] or some or one
of them of which is Owners or is in the Possession of]

lying or being at with in the County of Middx of the clear Yearly Value of [..]
forty Shillings, over and above all Rents and Charges Payable our of, or in respect of the
same; and that You have been in the Actual Possession or Receipt of the Rents &
Profile thereof, for your own use, above twelve & alondar Months, or that the
same came [..] you, within the time aforesaid, by Descent, Marriage, Marring Settlement,
Devise, or Promotion to a Benefice in a Church, or by Promotion to an Officer: And
that such Freehold Estate has not been Granted or made to you fraudulently, on
Purpose to Quali [..] e you to give your Note; And that the Place of your abode is
at in And that you are twenty one Years of Age, as you
believe: And that you have not been Polled before at this Election.

J do solemuly Affi [..]
I do swear I have not not received or had by myself or any Person [..]
whatsoever in [..] rnst 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 security for any Money Office Employment or Gift in Order to give my
Vote at this Election.

Jefferson.