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' PrinAed ay iPm A. i9 Sr.>nex IiuderYVOnd. Uovfiatr•
The honorable the Jutl~es of ttau (;oust of t:ommon Pleas of Ctemberlu;td County, holding
said Court at Carlisle, the /,~~~ day of (/~i~~' i8X; /
~~~~ ~ ~~~;~~p~ ;l~ ~~h-~~.~ ~-L~~'~4-"'~"~° respectfully represents,
`That he has resided within this state fur six months and more, immediately preceding this his
application; that he uffrre to deliver up to the use of his creditors, all his property, real, per-
sonal, and tn1XPd, to wViich he is in any wanner entitled ; a schedule whereof, together with a
list of his creditors and the nature of their dcbta, as far as be can ascertain them, with a state-
ment of iii losses and the means whereby he became insolvent, are exhibited with and annex-
ed #o this petition. !de therefore. prHys to he allowed the benefit of the several acts of Assem- .
~~ fly of the Cummoretvealth of Pennsylvu~niur made for the r~elie~f of Insolvent llebtors.~~, ,,~ ,
A Schedule of Petitioner's I'ropert~. ~ ~t,
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List of Petitior~r~'~ r~~r~'it~~rs, r~e~it~~ the nature and
AMOUNT OF T1iEIl'~ Dk~BTS.
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Statement of Petitioner's Losses, and the means
ZVliEfi,.~BY nL B~:LAi1~IL+~ INSOLV~;NT.
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~Cum~ber~anb ~~uttrv; ~~. ~`
The foregoing Petitioner being duly ~/U-`-°~''-~"~" according to law, Both say, that
all the facts contained in the foregoing Petition, Schedule, Lists and Statement, are true, to
the best of his knowledge and belief.
~-e~•-d,.-„~ and subscribed)
before me, the c~~C«.;,~.~'L~ ~ I ! / ,
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day of v'c~~G -- 18N / I%iJ
~~~#~' .,~~-~~~ ~~ ~~~~~~~$~$~2~.~~ That I
the within named Petitioner, do hereby assign, transfer, set over and deliver up, unto
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two of my creditors, in pursuance of the directions of the Act of Assembly, all my estate,
real, personal, sad mixed; reversions and remainders, which I now have, possess, claim,
or am in soy respect entitled to, iu any place whateveiy iu trust, fur themselves and my
other creditors. In witness whercof~ I have hereunto set my hand and seal, this ~z/~'~~
day of v~G~r , ~ ~ ~ in the ,gear of our Lord, 182 /
healed and Delivered
in the presence of 3
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