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MEMORIAL, OR APPLICATION FOR A CERTIFICATE OF NATURALIZATION.

[Attached Note]
To His Excellency Sir George Ferguson Bowen Knight
Commander of the Most Distinguished Order of
St Michael and St. George, Captain General and
Govenor in Chief of the Colony of Queensland
and its Dependencies also Vice Admiral
of the Force &c, &c, &c.

1. - The Memorial of Franz, Joseph, Chardon
of Plain Tree Creek, Dawson River respectfully sheweth,
that your Memorialist is a native of * Necarsulin in Wuteinberg
2. - That your Memorialist is tenty three years of age, and
is + a Builder by calling
3. - That your Memorialist arrived in the Colony of New South Wales, by the
ship "Undine" in the year 11th February 1854
and has been resident therein since that date.
4. - That your Memorialist beg to refer your Excellency to the annexed
Certificate of character and of the correctness of the statements herein contained from
respectable persons to whom the Memorialist has been known since his + arrival in the
Colony. +
5. - That your Memorialist s is desirous of Enjoying
s
the right & priviledges of an English Subject
in this his // adopted Country
; and that on these grounds your Memorialist is
desirous of availing himself // of the privileges granted to Aliens by the Acts of Council,
11 Victoria, No. 39, and 17 Victoria, No. 8.
6. - That your Memorialist therefore respectfully requests that your Excellency
may be pleased o grant to your Memorialist a Certificate under the provisions of the said
Act, confering upon your Memorialist the privileges of a natural born British Subject,
with such restrictions as to your Excellency may seem met.
And your Petitioner will ever pray.

Sigature F. J. Chardon
_______________________

Date Fri. 12. Dezr. 1859
__________________________

______________________________

We, the undersigned, do hereby certify as to the correctness of the statements
contained in the subjoined Memorial, that we have known the Memorialist q// nearly
five years , and believe hin to be a person of
respectable character. H. P. Dutton
C. B. Dutton.

_______________________________________________________________________________

* Insert District or Town, and Country.

+ Profession, Trade, or Calling.

+ Or her.
+

s Here state the grounds on which the Certificate is desired.
s

// or herself.

q// From his arrival in the Colony, or from the (specific date).

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