FEB. 4.] THE NEW ZEALAND GAZETTE. 351

Improvements.
Value.
£ s. d.
Buildings as specified in the Second
Schedule hereto ..
[Specify other improvements in detail,
with their respective values.]
Total value .. £

Signed by the Commissioner, on be-
half of the lessor, in the presence
of—

Signed by or on behalf of the above-
named as lessee, in the
presence of—

SIXTH SCHEDULE.

APPLICATION for an Allotment of Land for Lease in Per-
petuity as a Workman's Home under "The Land for
Settlements Act, 1894," and its Amendments.

To the Commissioner of Crown Lands for the Land Dis-
trict of

I HEREBY apply for a lease in perpetuity of one of the fol-
lowing allotments as a workman's home :—

And I deposit herewith the sum of £ , being the
half-year's rent and other payments prescribed in respect of
the allotment applied for.*

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

*If more than one allotment is applied for the deposit should
be for the allotment requiring the largest deposit.

C

made thereunder, am applying for a lease of one of the
allotments described in the foregoing application.

3. That I am acquiring such lease solely for my own use
   or 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, being town or suburban
   land, exceeds one-eighth of an acre, or, being rural land, ex-
   ceeds fifty acres in area.

5. That the total value of all the real and personal pro-
   perty owned by me does not (after deducting the encum-
   brances thereon) exceed £150.

6. That my answers to the foregoing questions Nos. 1 to
   9 are true and correct in every particular.

And I make this solemn declaration conscientiously be-
lieving 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.

SEVENTH SCHEDULE.
(New Zealand.)

Lease in Perpetuity of Land as a Workman's Home unde
"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 his
executors, administrators, and permitted assigns, is herein-
after referred to as "the lessee"), of the other part :

Whereas the allotment of land described in the First
Schedule hereto has been acquired by the lessor under "The
Land for Settlements Act, 1894," and its amendments
(hereinafter called "the said Acts"): And whereas, pur-
suant 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
as a workman's home, and on the day of ,
one thousand , his application was duly de-
clared to be successful by the Land Board of the land
district wherein the said allotment is situate (herein-
after 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 in-
terest 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
said 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 aforesaid, and being allot-
ment 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, easements,
and appurtenances to the same belonging: To hold the said
several premises intended to be hereby demised unto the
lessee for the term of nine hundred and ninety-nine years,
to be reckoned from the first day of , one thousand
, and including, in addition, the broken period be-
tween the date of this lease and such day. Yielding and
paying therefor during the said term unto the Receiver of
Land Revenue for the said Land District of , free
from all deductions whatsoever, the clear annual rent of
, computed from the said first day of , one