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To the HoroR~ELE the Jl1d~CS of the Court of Common Pleas of CumLerlccncl Cozcntr/,
holain; said Court at Carlisle, the ~
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The Petition of ~~'`~ r ~ ~ ~ G ~'"`~'~-~ respectfully represents,
That. h~' 1-as resided with"this state for six mrniths and more, immediately pr~~~ceediug this 1-is
applicatiu-~; that he oficrs to deliver up t-- the. u~c of his creditors, all hi prc)perty, real, hc~t~,cmal
~t-~«-r,Tred, to which he is in auy manner entitled; a schedule whcmof', tuge~ther with a list of
his cr~~-lit--rs and the nature of ttlcir debts, a5 i~u• a5 he can a~ccrt.ain them, ~~ ith a statc'ill(•nt of
his loses and the menus ~tvherehy he hecanu~ insolvc--t, arc eshihitcd ~~~iih. and aun~~~ed t-- ibis
7~et~it~i~on. IIi:, therefure prays to be allowed the heuclit of the. several acts of ~~.5~enil~l~~, oflll'ic
~'orn~~zmawe~altlc of Pe~a7asylcania, made for the relief of Insolvei-t llchtors. ,~~~ ~~
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.~ Schedule of Pet,itioner's Pru~ert~.
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~..ist of 1"eliliuner's Credit~rG, n-ith tine nature anc~
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~t~a~cme~nt of 1'Pfif i~~er's Losses, ~tnc~. the meara~
WH~:REBY Ii ~ ~LCAI~1~ 1NSUI,VENT,
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~`IT~Tn7;ni..+1Nn C(1TT;~TY, SS.
The. forgoing Pctiiionc•r bcin~ du~y .,~-1--s,~.l-- ~ccor(ijn~ to law, cloth say, that 11I the
facts c~,tttain(•(1 111 tllE forl,;Ulllg Petition, Schedule, List, acid 5tatelllcllt, are true, to the best of
his luio~vlcclge and belief:
-~ .uccl ~uuscribcd ~'" r~~
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before me, tlt~• ~""'
day of ~~k~~~ ~ , ~ s 3~
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~n~w a111Vden by the a Presents; Thai I ~ ~ `` `~ ~ ~~ ° ~~ -~~ ~ `'
the within named PL`7'ITI01VEl>?, (lo hereby assign, ~ tisfcr, sei over and deliver up, unto
~.f« of my crcditoi:~, in jniisuance of the directions of• the 11ct of ASSemhly, all my estate,
real, pel'sUllal and mi~ecl, rcversioiiti aiicl remaiudc•r~, which I no~v 1 avc; p+,ssess, claim, or a)tt
in auy respect entitled to, in any place whatevci', in trust L'or -~~ ~
r•..zd uiy odic,,
ereditoi•s. Iu IYit~zess t~-hercof, I have hereunto set m v hand and seal, tl~is 1~ ~ ~~~'`
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y ~~ • l ~ ~^ ~ ` ~~ iu the year of our Lot~u. 1 s ~
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