2236
THE NEW ZEALAND GAZETTE.
No. 102

3. To the best of my knowledge and belief my wife’s (or husband’s) income for the aforesaid income-year was and no more, and was derived from the following sources, viz. :—

Total wages
Total of other personal earnings..
Total income from all other sources except from accumulated property

£

Total income from all sources except from accumulated property

[This paragraph is to be struck out if the pensioner is unmarried, or if husband and wife are living apart pursuant to decree, order, or deed of separation; and is to be marked “Nil” if no income has been received.]

4. The net capital value of all the accumulated property owned by me on the day of (being the day of the expiry of the aforesaid income-year) is estimated by me at £ , and no more, and the following are the particulars thereof:—

[If the pensioner has no accumulated property this paragraph is to be marked “Nil.”]

5. To the best of my knowledge and belief the net capital value of all the accumulated property owned by my wife [or husband] on the day of the expiry of the income-year as aforesaid is £ , and no more, and the following are the particulars hereof:—

[This paragraph is to be struck out if the pensioner is unmarried, or if husband and wife are living apart pursuant to decree order or deed of separation, and is to be marked “Nil” if the wife or husband does not own any property.]

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

Declared by the said , at , this day of , 1 , before me— , Justice of the Peace, [or, as the case may be, Solicitor, or Deputy Registrar for the Old-age Pension District, or Postmaster at (Name of post-town)].

Claimant.

To the Deputy Registrar for the Old-age Pension District.

INSTRUCTIONS TO PENSIONERS IN THE FILLING-UP OF THEIR INCOME AND PROPERTY STATEMENTS.

[To be printed at foot or on back of the Statement.]

By section 2 of the Act “income” and “income-year” are defined as follows:—

[Set out the definitions.]

By section 10 of the Act the following provisions apply in the computation and assessment of the net capital value of accumulated property:—

[Set out subsections (1) and (2).]

By section 12 of the Act the following provisions apply with respect to income:—

[Set out the section.]

By section 13 of the Act, as amended by section 3 of the Amendment Act, the following general rules apply in the computation of income:—

[Set out subsections (1) and (2), and Section 3 of the Amendment Act.]

By section 35 of the Act it is provided that the pensioner shall furnish his Income and Property Statement each year, whether claiming any payment in respect of his pension for the year or not.

Form 21 (Reg. 29).

Under “The Old-age Pensions Act, 1898.”

CIRCULAR AS TO INCOME AND PROPERTY STATEMENT.

To…………………

The year for which your pension-certificate, No. , was granted will expire on the day of , 1 , and, in order to ascertain whether you are entitled to a pension-certificate for the ensuing year, and, if so, for what amount, you must fill up the accompanying Income and Property Statement for the income-year ending on the day of , 1 , and send it to the Deputy Registrar at within seventeen days after the close of that income-year.

You must fill up and send in the Statement whether you claim a pension-certificate for the ensuing year or not.

Dated at , this day of , 1 .

Registrar.

Form 22 (Reg. 30).

Under Subsection (4) of Section 35 of “The Old-age Pensions Act, 1898.”

STIPENDIARY MAGISTRATE’S CERTIFICATE AS TO PENSIONER’S INCOME AND PROPERTY STATEMENT, ETC.

To the Deputy Registrar for the Old-age Pension District.

I HEREBY certify that I have investigated the Income and Property Statement of for the income-year ended the day of , 1 , and am satisfied on the following points:—

1. The pensioner’s income for the income-year was £ .
2. The net capital value of his accumulated property as at the end of the income-year was £ .
3. The conditions of section 8 of the aforesaid Act have been complied with [or, as the case may be, have not been complied with in so far as relates to subsection (s) numbered of that section].
4. For the year commencing on the day of , 1 , the pensioner is entitled to a pension of £ , payable by twelve equal monthly instalments of £ , at the Post-office Money-order Office [or, as the case may be, is not entitled to a pension].

Dated at , this day of , 1 .

Stipendiary Magistrate.

Form 23 (Reg. 32).

Under “The Old-age Pensions Act, 1898.”

STATEMENT TO BE FURNISHED BY MAORI CLAIMANT OR PENSIONER.

Full name of claimant :
Address :
Name of tribe or hapu :
PARTICULARS of all land in respect of which I claim or possess any customary rights or any interest:—