580
THE NEW ZEALAND GAZETTE.
[No. 24

I, the person making the foregoing return, do solemnly and sincerely declare that the same, and the statements therein referred to or accompanying such return, contain true and accurate details of the several matters and things set forth, and in particular contain a true and accurate account of all land in New Zealand owned by me as at noon on the 31st day of March, 189 , and of all mortgages of land in New Zealand held by me on the same date, and that the mortgages for which I claim deduction are mortgages which I am legally entitled to deduct. And I make this declaration under the provisions of "The Land and Income Assessment Act, 1891."

Dated this day of , 189 .

[All letters, &c., should be addressed "The Commissioner of Taxes, Wellington," and not to any name. Letters so addressed go free by post.]

Particulars of Money lent by me secured on Registered Mortgage, and any Amount owing in respect of Land sold on Time or Deferred Payment.

Person to whom the Money is lent.

Name. Occupation. Address.

Amount of Mortgage. £

Amount owing on 31st March, 189 , not including Interest. (The actual value of the mortgage to be inserted.) £

Particulars of Money owing by me secured on Registered Mortgage, and any Amount owing on Land purchased on Time or Deferred Payment.

Person to whom the Money is owing.

Name. Occupation. Address.

Amount of Mortgage. £

Amount owing on 31st March, 189 , not including Interest. £

[NOTE.—In the case of mortgagees who are not resident in New Zealand, the names and addresses of their agents should also be stated.]

Particulars of Land.

Assessment No. Local District or Borough. Freehold or Leasehold. No. of Section or Allotment. Street or Particular Locality. Area. A. R. P. Unimproved Value. £

[NOTE.—The unimproved value of each property should be shown separately. In the case of leased properties the owner's or lease-holder's interest in the land should be stated.]

SCHEDULE B.
COMPANY'S RETURN.
"THE LAND AND INCOME ASSESSMENT ACT, 1891."

In pursuance of the above Act, and of the regulations made thereunder, every company being the owner of land and every company being the owner of mortgages is required to fill up the following return as far as the same is applicable to its par-ticular case, and deliver the same at, or forward it by post to, the office of the Commissioner of Taxes, Wellington, not later than , 189 .

[NOTE.—Any person failing or neglecting to furnish a return, or any person making a false return, is liable to a penalty of not less than £5 nor more than £100, and to pay treble extra duty.]

Return of the Land and Mortgages of

[Name in full], [postal address], made in pursuance of "The Land and Income Assessment Act, 1891," and the regulations thereunder, so far as respects all land owned by the company and all mortgages held by the company as at noon on the 31st day of March, 189 , according to the several particulars hereinafter set forth, and of deductions at such date as are allowed by law.

Ordinary Tax.
Land owned by the company (particulars at back hereof) according to its unimproved value .. .. £
Mortgages of land held by the company (particulars at back hereof) according to the actual value thereof to the company as mortgagee, amounting to .. .. £
Total land and mortgages .. .. £
Deduct amount due or owing by the company on mortgage of above land (particulars at back hereof) .. .. £
Balance .. .. £

[The deduction by way of exemption allowed by law will be made in the Tax Office.]

Graduated Tax.
Land owned by the company, according to its unimproved value, included in the particulars at back hereof .. £

Balance .. .. £

N.B.—When filling in this form, please refer to last page.