THE NEW ZEALAND GAZETTE.
631
SCHEDULE W.
Application to form a Road or Tramway, or divert a Road, &c.
To the Warden of
hereby give notice that desire* from
to , as per sketch plan lodged herewith. The
length of such road or tramway, or diverted road, is feet,
yards, or thereabouts, and the proposed width is
and it is required for . It passes through the claims
undermentioned, situated at
(Signature of Applicants.)
(No. of Miners' Rights.)
Any person having any objection to this application must
lodge the same in writing at the Warden's office, at
(Date.) Warden.

• Alter the above statement to suit circumstances.

SCHEDULE A 1.
Certificate of Permission to make a Road or Tramway, or
divert a Road, &c.
No.
I hereby certify that received permission to*
[State conditions, if any.]
Dated at , this day of , 187 Warden.

• Here state particulars.

SCHEDULE A 2.
No.
Memorial for Registration of Claim, to be presented in duplicate
to the Registrar, who shall sign and return one copy thereof.
Locality.
Names of Owners
and Interests
held by them
respectively.
Nature of Claim.
State Day and
Hour of Mark-
ing out.
Distinguishing
Mark on Posts.
Give Name, Situa-
tion, and Area of
Claim, and, as
near as possible,
its Proximity to
fixed Points and
existing Claims.
Remarks.
(Signature of person applying for registration.)
Registered
(Date.) Registrar.

SCHEDULE A 3.
No. Part I. No. Part II.
Assignment or Transfer— Memo. of Assignment.
Date of Registration. Mining Registrar's Office, 187
Particulars— I have this day registered a document exhibited to me by
Assignor
Assignee
Date of Assignment
Nature of Property Assigned
Interest therein Assigned
Reference to Folio of Register
Fees Received
purporting to be an of which
assignment
the particulars are as follows:—
Name of Assignor
Name of Assignee
Date of Assignment
Nature of Property Assigned
Interest Assigned therein
Reference to Folio of Register
Fees received.
Signature of Assignee,) Mining Registrar.
or Agent presenting
Assignment
Original documents to be exhibited, and after being marked
by Registrar, to be returned to Assignee or his agent.

SCHEDULE A 4.
Memorial of Encumbrance.
To be presented in duplicate, and one copy signed and returned
by Registrar.
No.
Name of Interest
Claim. intended to
be affected
by such
Encumbrance.
Nature of Owner of
Interest. Encum-
brance.
Date
of Instru- Remarks.
ment.
(Date of Registration.)
(Signature of Grantor of Encumbrance.)
(Signature of Grantee of Encumbrance.)
(Signature of Registrar.)

SCHEDULE A 5.
Discharge of Encumbrance.
To the Mining Registrar.
TAKE notice that Encumbrance No. upon the interest
of in the claim has been satisfied and dis-
charged this day of 187 .
(Signature of Grantor of Encumbrance.) Registrar.
(Date of Registration.)

SCHEDULE A 6.
Depasturing Certificate.
having paid the sum of Two Shillings and Sixpence
per head for Cattle enumerated in the Schedule annexed, has
permission to depasture the same within the Hauraki Gold
Mining District for Twelve Months from the date hereof.
Horses, Mules, and Asses Number. Amount paid.
Horned Cattle
Sheep
Goats
Dated at this day of 187 . Warden.

SCHEDULE A 7.
Notice to Mining Inspector.
Warden's Office, 187 .
I HEREBY certify that the annual payments in respect of the
Licenses mentioned and described in the Schedule hereunder are
due, and have not been paid.
SCHEDULE.
Name of Licensee. No. of Description Amount When
License. of License. due. due.
Receiver of Revenue.

SCHEDULE OF FEES.
REGISTRAR'S OFFICE. £ s. d.
Registering each claim, licensed holding, water-right,
machine, residence, business site, or other autho-
rized holding, and every transfer thereof 0 2 6
Registering any share or interest in a claim or other
authorized holding, or any transfer thereof 0 1 6
Registering each amalgamation 0 5 0
Certificate of entry in Register—each entry 0 1 0
Registering memorial of encumbrance or discharge
thereof 0 2 6
Search—each claim, authorized holding, or address 0 1 0
Any other entry in the Register 0 1 0
RECEIVER OF REVENUE'S OFFICE. Fees as per Act.
Miner's Right ... 1 0 0
Business License, per year 5 0 0
" " per half-year 3 0 0
" " per quarter 2 0 0
Machine Site, per annum 10 0 0
Business Site 5 0 0
Residence Site 1 0 0
Water-right, race, dam, or reservoir 5 0 0
(Not exceeding two sluice-heads for a water-race,
and one pound for every extra sluice head.)
Other Fees.
Permission to cut kauri, per tree 1 5 0
Timber Certificate, per annum, not less than 5 0 0
Depasturing Certificate, per head, per annum 0 2 6
WARDEN'S OFFICE.
Duplicate Document 0 2 6
Certificate of Protection... 0 2 6
For each Certificate, Authority, or other Order by
Warden 0 2 6
On issue of Gold Mining License... 2 2 0
On application for Protection of Claim 1 1 0
On application to hold Licensed Holding with reduced
number of men 1 1 0
On application for right to Tunnel, to make Road or
Tramway, or to convey or discharge Débris, not
exceeding 2 2 0
(As may be ordered by Warden.)
For Survey and Report of Mining Inspector, when
required by Warden in special cases, not exceeding 3 3 0