We whose Names are hereunto Subscribed being
Members of a Congregation of Protestant Dissenters
from the Church of England meeting at Staines in
County of Middlesex , hereby Certify the Honourable
his Majesties Justices of the Peace for said County
and are Others whom it may concern That
William Headbourck< no role > of Norton Falgate in
said County is a Teacher and Preaches of the
Gospel to us and that we approve of him as such
Given under our hands this Nineteenth day of
February 1775.

Geo. Cater< no role >
Geo. Dexter< no role >
Wm. Banks< no role > }
Deacons

Jos. Attersoll< no role >
Wm Ford< no role >
Janes Kermyth< no role >
Peter Draper< no role >
James Treble< no role >