Proof of debt of workmen

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..... oyed by the above-named company, solemnly affirm and say: That the above-named company was, on the .............. day of .......... 19 ........., and still is justly and truly indebted to the several persons whose names, addresses and descriptions appear in the Schedule below in sums severaly set against their names in the seventh column of such Schedule for wages due to them respectively as wo .....

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