To the worshipful the Justices of the
Peace for the County of Middlesex
Assembled in their Quarters Sessions for
the said County

We whose Names are hereunto Subscribd being
Protestant Dissenters from the Church of England
Do hereby certify to your Worships that a House
in the Occupation of Jacob Buckey< no role > in
Mile End Road nearby opposite Globe Land
Mile End Old, Town in the County of
Middlesex has been appropriated and set
Apart for dwine Worship and we request
the same may be Licenced by your
Worships: asrecable to an Act of Parliament
made in the 1st. year of the Reign of than
late Majesty's King William and Queen
Mary intitled an act for exempting their
Majestys Protestant Subject dissenting
from the Church of England from the
Penalties of certain Laws
In witness whereof we have hereunto set our hand
this Tenth day of Sepetr In the year of our Lord one
Thousand Seven Hundred & Ninety nine

John Hopwood< no role >
Thos Lewis< no role >
Geo. Paramore< no role >
Wm. Jones< no role >

Robt [..]
Josh. Hesse< no role >
Peter Lecount< no role >