Nov. 3.] THE NEW ZEALAND GAZETTE. 1419

(M.)

“THE DECEASED PERSONS’ ESTATES DUTIES ACT, 1881.”
FORM of STATEMENT by Trustee under deed of settlement, to be filed with the Commissioner or Deputy-Commissioner within six months after the death of the settlor, pursuant to section 25 of the said Act.

Register No. 188 . Folio .

STATEMENT of all Real and Personal Property of or to which I , of , in the , am entitled as Trustee, under a deed of settlement made by the above-named deceased, for the benefit of .

PERSONAL PROPERTY.

Inventories, valuations, and vouchers must be annexed hereto.

Schedules giving detailed particulars must be annexed.

| Cash at bank ... ... |
| Cash in the house ... ... |
| Furniture, goods, chattels, and effects ... ... |
| Plate, jewels, and ornaments ... |
| Wines, spirits, and liquors ... |
| Horses, carriages, farming stock and implements ... ... |
| Stock-in-trade ... ... |
| Goodwill of trade or business... |
| Leaseholds—giving term, clear annual rent, and terms of renewal ... ... |
| Life assurance policies ... |
| Rents due at death of deceased |
| Mortgages, bonds, bills, &c., and interest due at death ... |
| Scrip stock shares of or in banks, companies, ships, societies, &c. ... ... |
| All other personal property not comprised in above ... |
| Deduct amount of debts due by deceased, and payable there-out ... ... |

Balance of personal property £

REAL PROPERTY.

Situation and extent of real property, with particulars of buildings thereon ... ... ...
Deduct amount of mortgages due thereon ... ...
Net balance of real property ... ... ...

Net total ... ... ... ... ...

DECLARATION.

, of , in the New Zealand, [severally] solemnly declare as follows:—

1. , the trustee under the deed of settlement made by , as settlor, deceased.
2. That, to the best of knowledge and belief, the above statement and all schedules and inventories annexed thereto are true in every particular, and comprise the whole of the property included in the said deed of settlement which did not at the time of the death of the settlor exceed the value of sterling, and that the valuations of such property are the just and true saleable values thereof at that date.

Declared by the said , this day of , one thousand eight hundred and eighty- , before me—

CERTIFICATE.

I CERTIFY that the final balance of the real and personal estate of the deceased, comprised in the foregoing statement, is £

Secretary for Stamps.

ASSESSMENT. £ s. d.
Value of property as per certificate ...
Less amount to widow absolutely under section 5 or section 40 ... ... ... ... ...
£

On £ , but not exceeding £100, exempt. £ s. d.
On £ , but not exceeding £1,000, at 2 per cent.
On £ , exceeding £1,000, but not exceeding £5,000, at 3 per cent. ...
On £ , exceeding £5,000, but not exceeding £10,000, at 4 per cent. ...
On £ , exceeding £10,000, but not exceeding £15,000, at 5 per cent. ...
On £ , exceeding £15,000, but not exceeding £20,000, at 6 per cent. ...
On £ , exceeding £20,000, but not exceeding £30,000, at 7 per cent. ...
On £ , exceeding £30,000, but not exceeding £40,000, at 8 per cent. ...
On £ , exceeding £40,000, but not exceeding £50,000, at 9 per cent. ...
On £ , exceeding £50,000, at 10 per cent. ...
£

Less proportion of duty to be refunded under section 37 to the children or grandchildren in respect of their share of the estate ... ... ... ...

Amount of duty due ... ... ... £

Deputy-Commissioner.

RECEIPT.

Stamp Office,

RECEIVED from , the sum of , for the duty assessed as above.

Deputy-Commissioner.

(N.)

“DECEASED PERSONS’ ESTATES DUTIES ACT, 1881.”

Register No. 188 . Folio .

To be used where too little duty has been paid.

AMENDED STATEMENT, under section 31 of the said Act, of all Real and Personal Property of or to which , late of , who died on the day of , 188 , was possessed or entitled at the time of his death (and the value thereof), exhibited by , as the Administrator of the estate and effects of the deceased.

Total net balance, as per account L, brought down ... ...

Items omitted in former statement must be set out in detail, and accompanied by vouchers.

Amended statement personal property ... ...

Deduct amount of additional debts due by deceased, and payable thereout ... ...

Amended statement—Real property ... ...

Deduct additional mortgages, &c., due by deceased ... ...

Total net balance ... ...

DECLARATION.

, of , in the , New Zealand, [severally] solemnly declare as follows:—

1. , the administrator of the estate and effects of the said , deceased.
2. That, to the best of knowledge and belief, the above statement is true in every particular, and the real and personal estate of the said deceased do not exceed the value of sterling.

Declared by the said , this day of , one thousand eight hundred and eighty- , before me—