[and if it be a town confifting of more streets than one, then Specifying in what street], in the and that I am enrolled county of in the register of freeholders for [Specifying the parish or diftritt in the register of freeholders of which such person is enrolled], in the county of and that I really and truly have, in the faid parish or diftrict [or, in the faid parish or district, and in Specifying in what other parish or district, if the cafe fhall fo be, in the faid county], an estate of the clear yearly value of forty fhillings, over and above the intereft of any money fecured by mortgage upon the faid eftate, and alfo over and above all rents and outgoings payable out of or in refpect of the faid eftate, other than parliamentary or parochial taxes; and that the faid eftate confifts of [Specifying whether the fame confifts of lands, or of meffuage, or of tithes, or of an office, or of a rent-charge; and if the faid eftate confifts of lands, or of messuage, or of both, then naming fome occupier of fuch lands or meffuage; or if the faid eftate confifts of an office, then naming the fame]; and that I am in the actual poffeffion or receipt of the rents or profits of the faid eftate for my own ufe; and that I do [or, do not, as the cafe may be] vote in virtue of a leafe [and if it be in virtue of a leafe, then Specifying the date of the faid leafe, and the christian names and the furnames of the parties. thereto; and that I have not been polled before at this election; and that, to the best of my knowledge and belief, I am of the full age of twenty-one years, and have in my faid eftate a freehold. No. XXXIII. Declaration of Freeholder at the Pall, purfuant. 20 to 28 G. 3. c. 36. .. I from the 10th DO declare, That I have been enrolled, at To take effect least twelve calendar months, in the re- of July 1790. gifter of freeholders for of [Specifying the parish or district in the register of freeholders for which fuch perfon is enrolled], in the county and that I have, by myself or others, been, for at least twelve calendar months laft paft, in the actual poffeffion or receipt of the rents or profits, for my own ufe, of the estate for which I claim to vote at this election. No. XXXIV. Declaration where the Freehold has come to the Voter within two Years, pursuant to 28 G. 3. c. 36. I DO declare, That the estate for which I To take effect claim to vote at this election, came to me within two years laft paft, by the death of [Specifying the chriftian name and the furname of the perfon by whofe death the perSon claiming to vote shall have acquired fuch eftate; or], or by promotion to the benefice [or], or by promotion to the [or], or by marriage [as the cafe may be]. of office of with from the oth of July 1790. No. XXXV. Schedule referred to by the 28 G. 3. c. 36. Specifying the Form of the "Register of Freeholders" for in the County of Freeholder's Chriftian name and furname Freeholder's addition, profeffion, or trade Freeholder's ufual place of a- ឃ bode, and if in a town, nam- Freehold eftate (that is) whether r do certify, That who acts as register-keeper for the above-mentioned diftrict, perfonally appeared this day before me, and informed me, that (to the beft of his knowledge, information, and belief) the person whose name is enrolled in the above enrolment has difpofed of his eftate || is dead. in the faid district. Witness my hand, Witness my hand, juftice. juftice. No. XXXVI. Schedule referred to by 28 G. 3. c. 36. ftating the Form of the "Atteftation." I of REQUEST to be enrolled in the register of freeholders for in the county and I do folemnly fwear [or, being one of the people called Quakers, I do folemnly affirm], That my name is A. B.; and that I am [Specifying the addition, profeffion, or trade of fuch perfon]; and that the ufual place of my abode is at [and if it be in a town confifting of more streets than one, then Specifying in what street], in the county of and that I really and truly have, in the faid parish or diftrict [or, in the faid parish or diftrict, and in Specifying in what other parish or district, if the cafe fhall fo be, in the faid county], an estate of the clear yearly value of forty fhillings, over and above the intereft of any money fe cured by mortgage upon the faid eftate, and alfo over and above all rents and out-goings payable out of or in refpect of the faid eftate, other than parliamentary, public, or parochial taxes; and that the faid eftate confifts of [Specifying whether the fame confift of lands, or of meffuage, or of tithes, or of an office, or of a rent-charge; and if the faid eftate confift of lands, or of meffuage, or of both, then naming fome occupier of fuch lands or meffuage; or if the faid eftate confift of an office, then naming the fame]; and that I am, by myfelf or others, in the actual poffeffion or receipt of the rents or profits of the faid eftate for my own ufe; and that, to the best of my knowledge and belief, I have in my faid eftate a freehold. Witnefs my hand, this day of one thoufand dred and The faid Oath [or, Affirmation] was taken and fubfcribed, on the day hun A. B. and year aforefaid, before me C. D. |