792

THE NEW ZEALAND GAZETTE.

Folio......

REQUISITION D (Impressed Fee Stamps).

REQUIRED by
of , Fee Stamps of the following
numbers and denominations (to be impressed on the forms here-
inafter particularized).

| Description of Form
Required. | Number of
Stamps. | Value of
each, | Amount.
| :--- | :--- | :--- | :--- |
| | | £ s. d. | £ s. d. |
| Amount | | | £
| Less commission at the rate of | per cent... | |
| Net amount | | | £

Signature of Applicant.
Date. 18

(G.)
RECEIPT for SPOILED STAMPS
Stamp Office, 18
No.

I CERTIFY that of , has this day de-
posited at this Office the Stamp particularized on the back
hereof for allowance, accompanied with an Affidavit duly sworn,
setting forth how the same w rendered useless.

Stamp Clerk.

If the allowance is granted, this receipt must be exchanged
for Stamps in lieu of those for which allowance has been made,
within one month from the date hereof.
This receipt is not transferable.

(Ε.)
No. of Requisition ......... Folio.

ABSTRACT of INSTRUMENT requiring to be STAMPED
AFTER EXECUTION.

| Date of
Instrument. | Nature of
Instrument. | Names of Parties. | Considera-
tion Money:
£ s. d. | Duty. £ s. d. | Fines. £ s. d. | Stamps
Issued.
| :--- | :--- | :--- | :--- | :--- | :--- | :--- |
| | | | | | | |

Date of Application
Signature of Applicant
Amount of duty payable, £
:
Amount of fine payable, £
:
Deputy Commissioner.
18

(F.)

AFFIDAVIT OF AFFIRMATION to be made to obtain
ALLOWANCE OF SPOILED STAMPS.

Deponent must state
here his name, ad-
dress, and descrip-
tion.
}
of maketh oath and saith
Where affirmation made, this form can that the several Stamps hereinafter specified
be so altered. and described, that is to say,ー

| Number of Stamps. | Value
of each. | Description
of
Instrument. | Total Value.
| :--- | :--- | :--- | :--- |
| | £ s. d. | | £ s. d. |

are the property of this deponent,
by
or for
use, and that
and were purchased
paid or now
stand indebted for and really and truly liable to pay the full
amount or value thereof.
Here state cause for
rendering the Stamps
useless.

And this Deponent further saith, that he hath not in any
way been reimbursed or paid the value of the said Stamps,
or any part thereof, by any other person or persons, and
that, if the value shall be allowed by the Commissioner of
Stamps, he will not ask or receive any compensation for the
same or any part thereof, from any other person or persons, or
charge the same or any part thereof, in account or otherwise, to
any other person or persons, either generally or particularly, so
as to be again paid or compensated for the same, or any part
thereof, directly or indirectly, in any manner whatsoever.
Sworn at
day
of 18
, before me
}

NOTE.—This form is to be filled up so as to suit the circum-
stances affecting each particular case, and in terms of the
Regulations (see page 3).

(H.)

FORM of DECLARATION of the Consideration paid for
a RUN or STATION held under Lease or promise
of Lease or in any other manner from the Crown,
or of any Interest therein.

I, , of , do solemnly and sincerely declare,ー

1. That on the day of last, I purchased from
   of , the whole property and interest in a
   certain Run or Station situate at and held by him
   under on behalf of the Crown, dated the day of
   18 , together with the improvements and stock thereon, at or
   for the price of
2. That the said sum of is the whole consideration
   paid or agreed to be paid for the interest of the said
   in the said Run or Station, improvements and stock.
   And make this solemn declaration conscientiously
   believing the same to be true, and by virtue of the provisions
   of "The Justices of the Peace Act, 1866."

Made and subscribed at , in the
Colony of New Zealand, this day of , one thousand eight
hundred and before me

(J.)

NOTICE.

To the Manager of the

THE declared Returns furnished by the , pursuant to
"The Bankers' Returns Act, 1858," show that the average total
value of the Notes of the said Bank in circulation in the Colony
of New Zealand during the Quarter ended on the day
of 18 , amounted to sterling.
The amount payable under "The Stamp Act, 1875," by way
of composition on the sum above mentioned, is assessed at
sterling, and you are accordingly required to pay
that amount to the Commissioner of Stamps, at this Office.

Head Office, Stamp Department,
Wellington, , 18

Head Office, Stamp Department,
Wellington, , 18.

RECEIVED from the the sum of sterling, being
the amount payable by way of composition on the amount of
Notes of the said Bank in circulation in the Colony during the
Quarter ended the day of 18

(Κ.)
Stamp Office, , 18

Register No. 18 Folio

SIR,-As Administrator* under "The Stamp Act, 1875," of
the real and personal estate of , late of
deceased, I have to call your attention to the provisions of Part
III. of the said Act..

• Under section 105 of the said Act, "Administrator" includes Executor,
  Administrator, and also any person succeeding to any property where no
  probate or letters of administration are required to be issued, &c.