Page:UKSRO 1890.pdf/65

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BANKRUPTCY, ENGLAND.
29

B.

Creditors Fully Secured.

No. Name of Creditor. Address and Occupation. Amount of Debt. Date when contracted. Consideration. Particulars of Security. Date when given. Estimated Value of Security. Estimated Surplus from Security.
Month. Year.
                                 

Signature

Dated⁠ 189⁠.

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