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Piirt ted hA Ti'+n- R. F3 Jnerxex [lvu/erxuoot~, Cnrlirele.
the Hona`rable the Budges of the Caurt of Common Pleas of Cumberland Coun:y, holding
said Court at Carlisle, the day of i8Q
~~~ ~~~~~~~~ ~]~ respectfully represents,
That he has resided within this state for six months and more, immediately preceding this his
application; that he o$ers to delir•er up to the use of his creditors, all his property, real, per-
sonal, and mixed, to which he is in any manner entitled; a schedule whereof, together with a
list of his creditors and the nature of their debts, as far as he can ascertaiu them, with a state-
ment of his losses and the means whereby he became insolvent, are exhibited with and annex-
ed to this petition. k[e therefore prays to be allowed the benefit of the several acts of assem-
bly of the Commonzvealtk of yennsylvar~aa, made for the relief of Insolvent DeUtors.
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.A. Schedule o~ Petitioner's Property. •.
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List of Petiti~nPr'~ rreditor~, ~~vit~h the nature and
AMOUNT OF TI3EI1~ DEBT~•
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statement of Petitioner's Losses, and the means
~VHEIi,EBY H {' BECAME; INSOLVENT.
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The foregoing Petitiouer being duly Wit,,,-~,~_ according to law, ~~oth say, that
all the facts contained in the foregoing Petitivn~ Schedule, List, and Statements are true, to
the best of his knowledge and belief,
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before me, the ~ ~ ~ - I
day of ~~jf '-; 18z / ~ `~
~~~~` ~~~ ~~~~ ~~,~~~~1; ' ~~~~~~~~~ That I a.
th/e~within named Pre~titioner, do hereby assign, transfer, set over and deliver up, ueto
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.twe of my creditors. in pursuance of the directions of the Act of Assembly, all my estate,
real, personal, and mixed, reversions and remainders, which I now have, possess, claim,
or am in any respect entitled to, iu any place wuatever, iu trust, fir themselves and my
other creditors. In witness whereof, I have hereunto set my hand and seal, this ~~ 'f
day of .ciy`dv'Z in the year of our Lard, 182 f
Se¢led and Delivered / ~ ~' year
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