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An assessment to the sewer rate [or other rate,&c., as the case may be] for the [name the district or town], made this day of in the year of our Lord 18 , after the rate of pence in the pound, by virtue of the [name special Act].
|No. on the rate.||Name of person rated.||Name of the owner of property rated.||Description and situation of property.||Gross annual value.||Full net annual value.||Rate atd. in the pound.||Amount of drainage rate (if any).|
Signed by us this day of in the year of our Lord
[or Borough, &c.]
Whereas complaint hath been duly made by , one of the collectors of rates to the Improvement Commissioners, that of, &c.,hath not paid and has refused to pay the sum of , duly assessed upon him in and by a certain rate for the said town [or district] called the [here name the rate], bearing date on or about the day of , in the year of our Lord one thousand eight hundred and , and duly made according to the directions and for the purposes of [here name the special Act], although the same hath been duly demanded of him: And whereas it appears to me , one of her Majesty’s justices of the peace in and for the said county (or borough, &c.], as well upon the oath of , one of the said collectors of rates, as otherwise, that the said sum of hath been duly demanded in writing by him from the said , and that the said hath refused to pay the same for the space of fourteen days after such demand made, and doth refuse to pay the same: And whereas the said , having appeared before me in pursuance of my summons for that purpose, hath not shown to me any sufficient cause why the same should not be paid [or And whereas it has been duly proved to me upon oath that the said hath been duly summoned to appear before me to show cause why he refuseth to pay the said rate or assessment, but he the said hath neglected to appear according to the said summons, and hath not shown to me any sufficient cause why the same should not be paid]: These are therefore, in her Majesty’s name, to command you to levy the said sum of by distress of the goods and chattels of the said ; and if the same shall not be paid within the space of days next after such distress by you taken, together with the reasonable charges of taking and keeping the same, that then you do sell the said goods and chattels by you distrained, and out of the money arising by such sale that you do detain the sum of , and also your reasonable charges of taking, keeping, and selling the said distress, rendering to him the said the overplus, on demand; and if sufficient distress cannot be found of the goods and chattels of the said whereon to levy the said sum of , that then you certify the same to me, together with this warrant, to the end that such further proceedings may be had therein as to the law doth appertain. Given under my hand and seal, the day of in the year of our Lord 18 .
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