346
THE NEW ZEALAND GAZETTE.
[No. 12

In proof of my fitness and qualifications to hold the land applied for, I hereby make the following replies to the under-mentioned questions:—

Declaration.

I, __, of __, __, do solemnly and sincerely declare—

1. That I am of the age of twenty-one years and upwards.
2. That I am the person who, subject to the provisions of “The Land for Settlements Act, 1894,” “The Land for Settlements Act Amendment Act, 1896,” and the regulations made thereunder, am applying for a lease in perpetuity of one of the allotments described in the foregoing application.
3. That I am acquiring such lease solely for my own use and benefit, and not directly or indirectly for the use or benefit of any other person or persons whomsoever.
4. That I am not, directly or indirectly, either by myself or jointly with any other person or persons, the owner, tenant, or occupier of any land whatsoever under “The Land for Settlements Act, 1894,” or its amendments, nor the owner in fee-simple, nor the tenant or occupier under a lease for a term whereof not less than two years are unexpired, of any other land in the colony which, with the largest allotment included in the foregoing application, would exceed in area 1,000 acres.
5. That the total value of all the real and personal property owned by me does not, after deducting the encumbrances thereon, exceed the prescribed proportion of capital value (exclusive of buildings) of any allotment comprised in the foregoing application: And I am aware that the prescribed proportion is:—
   Three times, where the area of the allotment does not exceed 100 acres;
   Twice, where such area exceeds 100 and does not exceed 500 acres; and
   One and a half times, where such area exceeds 500 acres.
6. That my answers to the foregoing questions (Nos. 1 to 11) are true and correct in every particular.

And I make this solemn declaration conscientiously believing the same to be true, and by virtue of an Act of the General Assembly of New Zealand intituled “The Justices of the Peace Act, 1882.”

(Signature in full.)

Declared at __, this __ day of __, one thousand __, before me—

(Signature),

A Justice of the Peace in and for the Colony of New Zealand (or as the case may be).

Received on __, at __.

Commissioner of Crown Lands.

SECOND SCHEDULE.

TABLE for calculating the Half-yearly Instalment to be paid by the Lessee for any Number of Years from 5 to 21 in respect of Value of Buildings or Repayment of Advances.

EXAMPLE.—If the ascertained value of the buildings is £225, and the number of years is 10, then £6 9s. 6d. × £225 / 100 = half-yearly payment = £14 11s. 5d.

THIRD SCHEDULE.

(New Zealand.)

Lease in Perpetuity of Rural Land under “The Land Act, 1892,” and “The Land for Settlements Act, 1894,” and the Amendments thereof.

THIS DEED, made the __ day of __, one thousand __, between Her Majesty the Queen (who, with Her heirs and successors is hereinafter referred to as “the lessor”), of the one part, and [Full name] of [Residence], in the Colony of New Zealand [Occupation] (who, with executors, administrators, and permitted assigns, is hereinafter referred to as “the lessee”), of the other part:

Whereas the allotment of land described in the First Schedule hereto is rural land which has been acquired by the lessor under “The Land for Settlements Act, 1894,” and its amendments (hereinafter called “the said Acts”): And whereas, pursuant to the provisions of the said Acts and the regulations in that behalf made thereunder, and under “The Land Act, 1892” (hereinafter called “the said regulations”), the lessor duly applied for a lease in perpetuity of the said allotment, and on the __ day of __, one thousand __ his application was duly declared to be successful by the Land Board of the Land District wherein the said allotment is situate (hereinafter called “the Land Board”): And whereas there are now situate on the said allotment the buildings specified in the Second Schedule hereto, the value whereof has been duly ascertained to be the sum therein mentioned: And whereas pursuant to the provisions of the said Acts and the said regulations, the said sum, together with interest thereon at the rate of five per centum per annum, computed from the first day of __, one thousand __, is payable by the lessee by the respective instalments and on the respective dates mentioned in the Second Schedule hereto: And whereas the capital value of the said allotment, apart from the said buildings, is __:

Now this deed witnesseth that in consideration of the rent hereinafter reserved, and of the covenants, conditions, and agreements herein contained and implied and on the part of the lessee to be paid, observed, and performed, the lessor doth hereby demise and lease unto the lessee all that piece of land containing by admeasurement __ acres roods perches, a little more or less, situated in the Land District of __, and being allotment numbered __ of the __ Estate, as the same is more particularly described in the First Schedule hereto and delineated in the plan drawn thereon, it being therein coloured red in outline; together with the rights, ease-