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nrr+ifed Lv D3~m S. fl .lama.a LIve~le~rurnd, Cnrliale. _ _-
'~'he $onora,ble the Judges of the Court of l'ommon Pleas of Cumber°land Cou~ity, holding
said Court at Carlisle, the ~ `` -- --- _ -day of ~, fly<<~`~ - 38~/
~~~~~~~~~~~ ~~ `%j,,.y c~,e~~,-~~---- respectfullyrepresents~
That he has resided within this state for six months and more, immediately preceding this his
application; that he offers to deliver up to the use of his creditors, all his property, real, per- -
zonal, and mixed, to which he is in any manner entitled; a schedule whereof, together wlth a
list of his ereilitors and the nature of their debts, as far as he can ascertain them, with estate- `
went of his losses and the means whereby he became insolvent, are exhibited with and annex-
ed to this petition. He therefore prays to he allowed the benrfit of the several acts of ~ssem-
1J]y of the Commonwealth of Pennsylvania, made for the relief of Insolvent Debtors. ,
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~ Schedule of Petitioner's Property.`
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List of Petitioner's Creditors, with the nature and
AMOUNT OF THEIR DEBTi9.
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Statement of Petitioner's Losses, and the means
WliEIi,EBY H>J BE(lAM1J INSOLVENT.
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The foregoing Petitioner being duly ~~~-r ~ . ~ ---._ ---- according to law, Both say, that
all the facts contained in the foregoing Petition, Schedule, List, and Statement, are true, to
the best of his knowledge and belief.
'~4~ ~~~ ~~ ~`~ ~~4~~ ~~t!~'tsot~, That I ~
i/~.- r~,~ -------and subscribed
before men the ~~ ~ ~,~.~r
day of.4f~-,t/r~L/ j 18~/~
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the within named Petitioner, do hereby assign, transfer, set over sad deliver up, unto
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two of my creditors. in pursuance of the directions of the Act of Assembly, ell my estate,
real, personal, and mixed, reversions and remainders, whicl- I now have, possess, claim,
or am in any respect entitled to, in any place whatever, in trust, for themselves and my
other creditors. In witness whereof, I have hereunto set my hand and seal, thin ~,~ ~~
day of cl`-~ .~<1 - _in the year of our Lard, 18~/
Sealed and Delivered
inn-the ~reaence of
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