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To the Ho~Torr:ini.~ tlic Jiicl;es of tllc Court of Common Pleas of CtanlLe~•lccncl C`nzc~~fy,
holding said Court at Cu~•li•sle. the =~ ~ y -`~ ~'~= clay of ~ ' ~ ~'~ ~ _ • • <• ~ - ' 18 A 3 <
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The Petition of~. -~%~ ~ f ~, ,~/`~°~' respectfully represents,
That he has resided within this state for sie months and mire, immediatel3• prr~cecdin~ this his
a}~plication; that he offers to dcli~~er -~}~ to the u.c of his creclitoi•~, all liis }~rnp~+rt}•. real. Pcr~~;nal
and n-i~cd, t~ which he is in any~uaunc•r e~tiilcd ; a scl-cclule ~~'hercc-f, tc-~;c~tlier with a list ~-f
his ca•cditors.•~~ul t11C Ilat.llrc ot'•t:~ienili~fit~. as fai~ as he can .-ticertain th~•n~. «-ith a slat-`m~•ut c-1'
l~i• losses a~ut the means wltcreby he hce:i-nc inulvc--1, arc c`~hil~iteel ~~~ith. and annc`~cel tc- this
petitio~t. IIU, therefore prays to be allo~~•cd tlic benefit c-f the se~-eral acis ul• Asscnii~ly, of tl~e'
+Con2mmtzveultJa of Pe~an~ylc~uniu, made for the relief of Insolvent ll~~i~t~rs. -/
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.A. Schedule of+Petitiolter's ProPert~}r.
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~.ist of Z'etitioner's CrPClit~rG, r~-it1~ the nature and
~l,,~~iUUNT OFT ~'IR DEBTS,
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Statement o~~'c~tifiooer's Losses, and tie tueans
~'YkI1:REBX CIE BECAME 1NSQLVEN`~e
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(;~i~f'I3TR1~.4T~'il C(1T'A'TY, q.ri.
The i'orel;oii-;; Yeiii ioiicr being dull , r.~~ ~-~-~ according to ]aw, cloth say, tl~at:.all, the
facts contained in the Ibre;;oin~ I'ctition, Schedule, List, and Statement, arc true, to tlzc best of
Ilis kiiowled~;e acid belief'. /~ ~ ~.,
ti, ~, _ - uud subscribccl ~
before mc, the
day of ,~1/~ a-.-.., ~~ 1 3 3
know a1111PIen by t~iese I9re~ents; That 1 ~.~~.~~ ~<<~ ~ ~~'~'r•
the within nalncd 1'~TITIUNEIZ, do hereby aasin, transfer, set over and dcIiver ul~, uiit.~
,~,.` of my creditors, in ptu•suanec of the directions of the 1'1et of Assembly, all my estate,
Teal, 1?el'Ss~llal aIld I111YCd, 1'CVeI'S(UI1~ an(1 I'l'Inallldel'S, ~4'111C11 1 llt)~V have, pJSSCS~~, Clallil, OI' aln
in any respect entitled to, in any place ~ti'hatevcr, in trust for i<< ,...,F~ and my other
crecliturs. lu l~l~ilness whereof; 1 liat1e hcreuuto set my baud anti seal, this /G ~----
day of -~a.,~t----~~ -- iu flit year of our LoizL-. 1 8~_3 ~
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.Sculr•rl and clelr~•erert ~
aaa ~Iie l~rese~cce of ~
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