To the Right Worrspll that [..] Justices of the Peace for the County
of Middx

Sheweth

Yor humble peticon of William
parish of St. Leonard Shoredits
County

That pursuant to an Act of parish Intituled an Act for Granting to his Maty certain
Rates and Dutys Upon houses [..] making good the Deficiency of the Clipped
money Your Petr. is Rated an assessed wit him the said Parish the Sand of 6th.
as haveing Term windowe [..] in the house he dwellls in

That your petr. by reason of [..] verty is Discharged from paying either to
Church or Poore as by [..] ficate under the hands of the Churchwardens
of the sd. Parish may appears

Tho: Nash< no role >

Yor. Petr therefore most humbly Prayes yor
worspps to be pleased to Grant that he may be
discharged from paymt of the sd. Rate

And yor. petr. Shall ever Pray Etc

the M [..] ah of
Mary B [..] wife of
the [..] Baret