JB/124/059/001

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VI Forms
No 2 V Requiem

2
Petition for
Remittance

C2

Form of a Petition for Letter of Request Remittance from a Requiem Superannuation
Annuitant requesting praying an order in remittance of
his Annuity through the Post-Master of a
neighbouring Town.

To the Governor of the National General Panopticon Penitentiary House

Honoured Sir

[Town County this day of Day Month Year]
A [Quarter] Require

A Quarterly Half-yearly payment or [Quarterly Half-yearly
payments] of my Requiem Superannuation Annity, being having become,
due [or about to be due] the day of [Month[[Year Month Year]
[ Month ] [ Year ] and I being settled at or in the
neighbourhood of the Town of [] in the County
of [] and it being particularly convenient to me to receive
such payment at the said Town [or at the Town of] [ ] I do
hereby humbly request you to cause the said Sum
to be remitted to for my use to []
Postmaster for the said Town of [] Witness the hand
of Your dutiful and grateful Servant

3
Certificate for
County Post Master
of identity of
a Petitioners
Remittance

No 3

[C3]

Identity-Certificate from a Post Master
Certificate of the existence from the Post
Master of the and identity of the in favour of a Requiem Superannuation Annuitant to be annexed to
person signing a Letter as above purporting his Petition for Remittance. for
to be named on the Letter of a Requiem Annuity requesting
the remittance of his Annuity.

Sir To

Identifier: | JB/124/059/001"JB/" can not be assigned to a declared number type with value 124.
Date_1		Marginal Summary Numbering	2-3
Box	124	Main Headings	panopticon
Folio number	059	Info in main headings field
Image	001	Titles
Category	text sheet	Number of Pages	2
Recto/Verso	recto	Page Numbering	d5 / d6
Penner	jeremy bentham	Watermarks
Marginals	jeremy bentham	Paper Producer
Corrections		Paper Produced in Year
Notes public		ID Number	41748
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