〈…〉 _____ of _____ in the _____ aforesaid of the several Rates, Duties, and Sums of Money, Granted to His Majesty King William III. by Virtue of an Act of Parliament made in the Sixth and Seventh Year of His said Majesty's Reign, Entitled, An Act for Granting to His Majesty certain Rates and Duties upon Marriages, Births and Burials, and upon Bachelors and Widowers, for the Term of Five Years, for carrying on the War against France with Vigour.  
THESE are in his Majesty's Name, to require you, that you Collect and Levy the several Rates and Duties in the Estreat or Assessment hereunto annexed, as they shall respectively become due and payable, and all moneys and Rates due thereupon. And to that end you are hereby required to make Demand of the parties chargeable therewith, or at the places of their last abode, within ten days after the said Duties in the said Estreat or Assessment shall become due and payable; And if any Person or Persons shall refuse to pay upon your demand, the said several and respective Sum and Sums and proportions appointed for such Persons to pay; You are hereby Authorized and Required, for nonpayment thereof, to distrein the Goods or Chattels of such Person or Persons so refusing, and the Distress so taken to keep by the space of 4 days at the costs and charges of the Owner thereof; And if the said Owner do not pay the same within the said 4 days, than the said Distress is to be appraised by two or more of the Inhabitants, where the said Distress is taken, and there to be sold by you for payment of the said Money, and the Overplus coming by the said Sale, if any be over and above the charges of taking and keeping the said Distress, you are immediately to restore to the Owner thereof. And the better to enable you to Levy the Money Assessed by such Distress and Sale. you may lawfully break open in the day time any House; and by Virtue of this our Warrant, any Chest, Trunk, Box or other things where such Goods are, calling to your assistance the Constable, Tythingman and Headborough, within your said _____ where any refusal, neglect or resistance shall be made, which said Officers are hereby required to be aiding and assisting in the Premises, as they will answer the Contrary at their Perils. And where any Person or Persons chargeable with any Rates or Assessments, shall be under the Age of 21 Years: In every such case the Parents, Guardians and Tutors of such Infants respectively, upon default of Payment by such Infants, are by the said Act made liable to, and charged with the Payments, which such Infants ought to have made, and upon neglect or refusal, it shall and may be lawful for you to proceed against them in like manner as against any other Person or Persons making default of Payment as aforesaid.  
And the several Duties and Sums of Money due and payable, for and upon the Burial of any Person within the said _____ who in his or her life time, and at the time of his or her death was relieved within the said _____ by virtue of any Act of Parliament made for the relief of the Poor, shall be paid and answered by the Churchwardens and Overseers of the Poor of the said _____ And in default of Payment the said Churchwardens and Overseers are liable to be distrein'd upon, and prosecuted and punished in such manner as any other Persons neglecting or refusing to pay the Duties payable by them upon demand: And the Duties payable for and upon the Burial of any Person under the Age of 21 Years, who shall not be resident at the time of his or her death, with his or her Father or Mother, shall be paid by the Master or Mistress of the Family or House where such Person shall die, and in default of Payment, the said Duties and Sums of Money shall be levied by distress, and sale of the Goods and Chattels of such Master or Mistress, or otherwise as is before directed. And the several and respective Duties and Sums of Money granted upon the Burials of the several Persons in the said Estreat or Assessment, shall be answered and paid by the respective Heirs Executors or Administrators of every such Person so buried, before any other Debts or Duties whatsoever; and in default of Payment thereof, the same is charged upon, and to be levied by distress upon the Lands, Tenements and Hereditaments, or the Goods and Chattels of the Person so buried, in such manner as is herein before directed; and the respective Duties charged upon the Burial of any Person under the Age of 21 Years, is to be paid by the Father of such Person (if then living) and if the Father be Dead, by the Mother, (if she be then living) or otherwise by the Guardian, Trustee, Executor or Administrator of such Person; and the Duty charged upon the Burial of any Wife, to be paid by the Husband of such Wife.  
And the several and respective Sums of Money imposed for and upon the Birth or Births of any Child or Children, is to be paid by the Father, (if then living) and if he shall be Dead at the time of such Birth, by the Mother of such Child or Children so born, and in case of the Death of such Father and Mother, by such Person or Persons who shall take upon him, her or them, the Guardianship of such Child or Children so born.  
And the several and respective Duties, and Sums of Money to be raised and paid by Marriages, as the same shall severally become due and payable, is to be paid by the Husband upon demand.  
And the several and respective yearly Sums in the Estreat or Assessment charged upon Bachelors and Widowers, you are to Collect and Gather at the two most usual Feasts in the Year, (viz.) at the Feast of St. Michael, the Archangel, and at the Annunciation of the blessed Virgin Mary, by even and equal Portions.  
And the Assessment laid upon ourselves, and other the Commissioners for putting the said Act in Execution, or upon the Assessors. You are to Levy and Gather, as the same should and ought to have been, if we or they had not been Commissioners or Assessors.  
And you are hereby Required within the space of six Days after Receipt hereof, to deliver over the said Assessments or Certificates hereunto Annexed, or a true Copy thereof unto the Parson, Vicar, Rector or Curate of your said under the Penalty of forfeiting the Sum of Five Pounds, to the intent the same may be Openly and Publicly Read in the Church, on the Lord's Day next following.  
And you are further Required to make and deliver to the Receiver General for the said _____ or his Deputy, a perfect Schedule fairly Written in Parchment, under your Hands and Seals, Signed and Allowed by any two or more of Us, or other the Commissioners Acting for the said containing the Names. Surnames, and Places of Abode of every Person, as well Peer as Commoner, within your said _____ that shall make Default of Payment of any of the Sums that shall be Rated or Assessed on such Person, and the Sum and Sums charged on every such Person; to the intent, that the same may be by him returned into His Majesty's Court of Exchequer. Whereupon every Person making Default of Payment, may be charged by Process of the said Court.  
And for the better and more equal charging the Duties arising by the said Act, at the end of the Year, for which you are appointed Collectors, you shall cause a Copy, of the respective Assessments now delivered to you, and of the Collection that shall be made by you for the said _____ to be fairly Written and Signed by you, but with such Alterations therein, as shall be necessary, by reason of the Death, change of Quality, or Degree, or Removal of any Person or Persons, or otherwise; and at the bottom thereof, shall Write or cause to be Written, the Names of two or more of the most substantial Inhabitants of the said _____ whom you in your Judgement shall think fit to be appointed Collectors of the said Duties, within the said _____ for the ensuing Year. And you are also to deliver or cause to be delivered, the said Assessments so fairly Written, and Signed by you, together with the Names of the Persons nominated by you, fit to be Collectors, or a true Duplicate thereof, Signed as aforesaid, unto two or more Justices of the Peace for the said _____ within the space of Ten Days after the end of the Year, for which you are appointed Collectors as aforesaid, under the Penalty of forfeiting the Sum of 20 l.  
And you are to take such speedy and effectual Order and Care in the Premises, that you fail not to Pay the several and respective Sum and Sums of Money, as they shall respectively become due and payable, within Twenty Days after the Receipt thereof, unto the Receiver General of the said _____ his Deputy or Deputies, at _____ and thereof you are not to fail, as you will answer the contrary at your Peril. Given under Our Hands and Seals, the _____ Day of _____ in the Seventh Year of the Reign of our Sovereign Lord King William the Third, by the Grace of God, of England, Scotland, France, and Ireland, King, Defender of the Faith, etc. 1695.   

I do Approve of this Warrant, and do Licence Robert Vincent, Christopher Coningsby, and Joshua Brixey, to Print the same. April 29, 1695.  
Geo. Treby.   

Printed for Rob. Vincent in Cliffords-Inn-Lane, Chr. Coningsby at the Golden-Turks-Head over-against St. Dunstan's-Church and Joshua Brixey, at Clements-Inn-Gate, 1695.