906 THE NEW ZEALAND GAZETTE. [No. 44]

No. 38.—CLAIM FOR ASSAULT.
THE plaintiff claims £ damages for an assault committed by the defendant on the plaintiff on
the day of , 189 .

No. 39.—CLAIM BY HUSBAND AND WIFE FOR ASSAULT ON THE WIFE.
THE plaintiff claims £ damages for that the defendant, on the day of , 189
assaulted and beat the said [Hannah], the wife of the plaintiff, whereby she became sick and wounded
and unable to attend to her duties.

No. 40.—CLAIM FOR ASSAULT WITH SPECIAL DAMAGE.
The plaintiff claims £ damages for that the defendant, on the day of , 189 ,
assaulted and beat the plaintiff until he became insensible. The plaintiff was thereby prevented
from attending to his business [for six weeks altogether], and was compelled to pay £ for
medical attendance, which sum the plaintiff claims as special damages.

No. 41.—CLAIM FOR INJURY TO STOCK BY DOGS.
THE plaintiff claims £ , the value of [ten] sheep worried and killed, on or about the
day of , 189 , by the defendant's dog.

No. 42.—CLAIM FOR NEGLIGENT DRIVING.
THE plaintiff claims £ , damages sustained by reason of the defendant, on the day of
, 189 , by his servant, so negligently and unskilfully driving and managing a horse and cart
in a public highway that the same were forced against a horse belonging to the plaintiff, whereby the
horse was injured.

No. 43.—CLAIM FOR NEGLIGENT CARE OF PREMISES.
THE plaintiff claims £ for that, by reason of the defendant wrongfully suffering his cellar
immediately adjoining a public highway to be left open, without any railing, door, or fence, or other
protection, the plaintiff fell into the said cellar, and was wounded and seriously injured, and was
thereby prevented from attending to his business [for six weeks thereafter], and was compelled to
pay the sum of £ for medical attendance, which the plaintiff claims as special damages.

No. 44.—CLAIM AGAINST A LOCAL BODY FOR OBSTRUCTION ON A HIGHWAY.
THE plaintiff claims £ for that the defendant wrongfully suffered certain earth, stones, and
broken road-metal, placed by their servants on a public highway, to wit [High Street, in the Borough
of ], to remain there during the night without any light or means to prevent persons from
driving against the same, whereby the plaintiff driving along the said highway on the night of
the day of , 189 , drove his horse and gig against the said earth, stones, and broken
road-metal, and upset the gig, and broke and injured it and the harness, and injured and lamed the
horse.

No. 45.—CLAIM AGAINST CARRIER FOR LOSS OF GOODS.
THE plaintiff claims £ , the value of goods intrusted to the defendant on or about
the day of , 189 , to be safely carried for the plaintiff from to , and
there delivered in a reasonable time, and which were not delivered to the plaintiff.

No. 46.—CLAIM FOR UNLAWFULLY IMPOUNDING CATTLE.
THE plaintiff claims £ for that the defendant unlawfully seized and took the plaintiff's
cattle and impounded them, and kept them impounded for a long time, whereby the plaintiff
was deprived of the use of them, and incurred expense in getting them returned to him [viz.:
Pound fees, £ ; driving, £ ], and the cattle were deteriorated in value.

No. 47.—CLAIM AGAINST STEAMSHIP COMPANY FOR LOSS OF LUGGAGE.
THE plaintiff claims £ , the value of wearing apparel, and of the portmanteau which
contained the said apparel, delivered to the defendants to be safely and securely conveyed with the
plaintiff as his luggage from to , on the day of , 189 , and lost by
the defendants.

No. 48.—GENERAL FORM STATING SEVERAL CAUSES OF ACTION.
THE plaintiff claims £ for goods sold and delivered, goods bargained and sold, for work
done and materials provided, for money lent, and on accounts stated as follows: [Insert dates,
items, and amounts, and credit sums paid on account, if any].