APRIL 3.] THE NEW ZEALAND GAZETTE. 585

SCHEDULE E.

"THE LAND AND INCOME ASSESSMENT ACT, 1891."

In pursuance of the above Act, and of the regulations made thereunder, every company in receipt of income within the meaning of the said Act is required to fill up the following return as far as is applicable to its particular case, and deliver the same at or forward it by post to the office of the Commissioner of Taxes, Wellington, on or before the day of
, 189.
, Commissioner of Taxes.

[NOTE.—Any company failing or neglecting to furnish a return at the prescribed time, or any company 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 Income of

[Name of company in full], [postal address], made in pursuance of "The Land and Income Assessment Act, 1891," and the regulations thereunder.

Income derived during the year ending 31st March, 189 : £ , being gains and profits derived or received by the said company during such year, as per details shown within.

[NOTE.—The income of a company shall include dividends earned, sums carried to reserve fund, and any other profits made or income derived during such year.]
[N.B.—Income derived or received by the owner or occupier of land in New Zealand from or out of land, or from the use or produce of such land derived by such owner or occupier, or from mortgages of land in New Zealand, except where otherwise specially provided, should not be included in the gross income; and losses, outgoings, and expenses incurred in the production of such income from land or mortgages cannot be deducted.]

I, , being the duly-appointed public officer of the above-named company, and in that capacity duly authorised to make the above return, do solemnly and sincerely declare that I am well acquainted with the affairs of the said company, and that the said return contains a true and accurate statement of the income of the company for the year ending the 31st March, 189 ; and that the copy of a balance-sheet hereto attached is a true copy of the balance-sheet of the said company issued to shareholders, or prepared for issue, last prior to the date of this return.
Dated this day of , 189.
Usual signature:

Return as Agent for Holders of Debentures.

Return of the income received or receivable, for the year ending the 31st March, 189, by the holders of debentures issued by the Company, in respect of money borrowed on debentures by the company: £
I, , being the duly-appointed public officer of the above-named company, and in that capacity duly authorised to make the above return, do solemnly and sincerely declare that I am well acquainted with the affairs of the said company, and that the said return contains a true and accurate statement of the income, for the year ending the 31st March, 189, of the debenture-holders in respect of money lent to the said company on debentures.
Dated this day of , 189.
Usual signature:

I claim to have deduction made from net income shown on page 1 on account of liability to pay land-tax in respect of land occupied for business or employment, such deduction being equal to 5 per cent. on the amount upon which the company is liable to pay land-tax on such land under Schedule A, "Land and Income Assessment Act, 1891."

| Assess- | Description of Land used as Place of Business | Actual Value. | Value of | Amount of | Amount on |
| ment No. | or Employment. | | Improvements. | Mortgage. | which Land-tax |
| | | | | | payable. |
| | | | | | |

[N.B.—No deduction can be claimed by the owner in respect of premises or portion of premises let to a tenant.]

STATEMENT to be made by Government Departments, Local Authorities, Persons, Firms, Companies, and Societies employing Officers, Managers, Travellers, Clerks, Foremen, Workmen, Servants, and Others in New Zealand, whether paid by Salary, Weekly Wage, or Otherwise.

List of Persons in the Service or Employ of the Company.

| Name in Full. | In what Capacity | Place of Residence. | Amount of Pay received, |
| | employed. | | including Salary, |
| | | | Wages, Bonus, Com- |
| | | | missions, |
| | | | and Allowances. |
| | | | |

[In the case of any person the total payment to whom does not exceed £160 a year, an entry need not be made.]

List of Directors, Auditors, and Others to whom any Payment has been made.

| Name in Full. | In what Capacity employed. | Address. | Amount of Fees, |
| | | | Salary, Bonus, |
| | | | &c. |
| | | | |

[All amounts paid should be included in this list.]

[If there should not be sufficient space in any of the above forms, a sheet giving the required information may be attached.]