Ladies please state if Mrs or Miss.
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Residence
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Write legibly in ink.
Occupation
................................................................. Do not fold this Card.
The Guarantor’s name must appear on the current Burgess Roll, failing which, the production of the last receipt for payment of Poor Rate, or a lease showing the occupancy of a whole premises, or a rent book showing the occupancy of a whole premises, will suffice. The guarantee lasts two years, unless previously withdrawn in writing by the Guarantor.
Ward .....................
No. on Burgess Roll ..............