I Allow this to be Printed.  
Rob. Atkyns.   

ss. To _____ being by us approved and appointed Collectors for the _____ within the _____ of the Moneys payable to Their Majesties by virtue of an Act of this present Parliament, Entitled, An Act for a Grant to Their Majesties of an Aid of Twelve Pence in the Pound for one Year for the necessary Defence of Their Realms.  
THese are in Their Majesty's Name to Will and Require you, That you Collect and Levy of the several and respective Person and Persons in the Estreat or Assessment hereunto annexed mentioned, the several and respective Sum and Sums of Money on them respectively Rated or Assessed; And to that end you are by the said Act required to make demand thereof of the Parties themselves within six days after the Receipt hereof; And if any Person or Persons shall neglect or refuse to pay, upon your demand, the several Rates and Assessments wherewith he is Charged by the said Act for or in respect of his Goods, Chattels, Personal Estate, Offices, or Employments, and which he ought to pay; Or if the Pound Rate, or any Payment thereof charged upon any Manors, Messages, Lands, Tenements, Hereditaments, and Premises, shall be neglected or refused to be paid, you are hereby Authorized and Required to Distrein the Person or Persons so refusing or neglecting to pay, by his or their Goods or Chattels, or to distrein in and upon the Message, Lands, and Tenements so Charged, and the Goods and Chattels then and there found, and the Distress so taken to keep by the space of four days at the cost and charges of the Owner thereof, and if the Owner do not pay the same within the said four days, the said Distress is hereby directed to be appraized by three or two of the Inhabitants where the Distress is taken, and there by you to be sold 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, it is by the said Act declared lawful to break open in the day time any House, and by virtue of this our Warrant, any Trunk, Chest, Box, or other things wherein any such Offenders Goods are, calling to your assistance therein the Constables, Tythingmen, and Headboroughs within your _____ where any refusal, neglect or resistance shall be made, as by the said Act of Parliament is directed, and they and every of them are hereby required to be aiding and assisting unto you in the Premises; And where no sufficient Distress is to be found, you are to make and deliver to the Head-Collector a perfect Schedule fairly written in Parchment under your Hands and Seals, to be allowed by two or more of us (or other) Their Majesty's Commissioners for the said _____ containing the Names, Surnames, and places of abode of every person within your Collection who shall make default of Payment, and of the Sum and Sums charged on every such Person, to the end the same may be returned into Their Majesty's Court of Exchequer, and the person so making default of payment may be charged by Process of the said Court; And in case any Lands or Houses within your Collection shall be unoccupied, and no Distress can be had for the same, nor the true Owner found, by reason whereof the Rates and Assessments upon such unoccupied Lands cannot be levied, you are to make complaint thereof to us, to the end the same may be by us Certified into Their Majesty's said Court of Exchequer, and the Persons made Debtors to Their Majesties, and Processes issued out against the Body, Goods, and all other Lands of such Debtor, until the same be fully paid; And where any Person or persons chargeable with any Rates or Assessments by the said Act imposed, shall be under the age of 21 years, in every such case their Parents, Guardians or Tutors respectively, upon default of payment by such Infant, are made liable and chargeable with the payment which such Infants ought to have made, and upon neglect or refusal may be proceeded against in like manner as against other Persons making default of payment as aforesaid. And the several and respective Tenants of all and every the Messages, Manors, Lands, Tenements, Hereditaments, and Premises, which by virtue of the said Act shall be charged with any Pound Rate, are hereby required to pay such Sums of Money as shall be rated upon the same, and to deduct out of the Rent so much thereof as in respect of the Rents the Landlord ought to bear; But the Tax or Assessment which shall be made or imposed in respect of any House or Tenement which any Ambassador, Resident, Agent, or other Public Minister of any Foreign Prince or State, doth or shall Inhabit or Occupy, is to be paid by the Landlord or Owner respectively; And the Tax or Assessment made or imposed upon the Shares or Interest in the New-River or Thames, Hyde-park, or Maribone-water-works, or on the Stock or Stocks of all Companies of Merchants in London, charged by the said Act, and on the Stock and Shares for Printing, are to be paid by the Governors and Treasurers of the said Companies, and Treasurers of the said Water-works, and Stock for Printing; And the Assessment laid upon ourselves or any other Their Majesty's Commissioners for putting the said Act in Execution, you are to levy and gather as it should or ought to have been, if we or they had not been Commissioners; And you are further Required to take such speedy and effectua Order and Care in the Premises, that you fail not to levy and pay into the Head-Collector of the said _____ the total Sum of _____ (Being tne _____ Payment (or one moiety) of the Moneys charged upon your said _____ by virtue of the said Act) at such place as shall be appointed you within ten miles of your said _____ on or before the _____ day of _____ now next coming: Hereof you are not to fail, as you will answer the contrary at your utmost Peril.  
Given under our Hands and Seals the _____ day of _____ in the First Year of the Reign of our Sovereign Lord and Lady William and Mary, by the Grace of God, of England, Scotland, France, and Ireland, King and Queen, Defenders of the Faith, etc. Annoque Dom. 1689.