JUNE 18. THE NEW ZEALAND GAZETTE. 1173

Form 57 (Reg. 85).
Under “The Mining Act, 1898.”
APPLICATION FOR REGISTRATION AND LICENSE IN RESPECT OF MACHINE.
To the Mining Registrar of the Mining District, at

Pursuant to “The Mining Act, 1898,” the undersigned [Full name, residence, and occupation], being the owner of the process or appliance specified in the Schedule hereto, hereby applies for the registration of the same, and for the issue of a license to him in respect thereof.
Dated at , this day of , 19 .

SCHEDULE.
[Specify the process or appliance, and also the locality where it is to be used.]
[Signature of applicant, &c.]

Form 58 (Reg. 85).
Under “The Mining Act, 1898.”
MACHINE REGISTER-BOOK. License No.

Form 59 (Reg. 85).
Under “The Mining Act, 1898.”
MACHINE LICENSE.

No.
Pursuant to “The Mining Act, 1898,” A.B., [Full name, residence, and occupation], of , is hereby licensed as the owner of a registered [Here describe machine, e.g., a 12-stamp crushing machine, a berdan, amalgamator, retort, melting-furnace, or otherwise] at [Place where machine situate] until the 31st day of December next.
Fee, 1s., paid.
Dated at , this day of , 19 . Mining Registrar.

Form 60 (Reg. 85).
Under “The Mining Act, 1898.”
MONTHLY RETURN BY LICENSEE, MACHINE REGISTERED No. , OF WORK DONE BY HIS MACHINES DURING THE MONTH OF .

A true return.
Dated , 19 . A.B., Licensee.

NOTE.—On lines 4 and 5 are to be entered only such amalgam or gold and silver as is not the produce of what is included under lines 1, 2, and 3 in the above return.

Form 61 (Reg. 88).
Under section 109 of “The Mining Act, 1898.”
CLAIM SETTING FORTH FULL PARTICULARS OF THE COMPENSATION THAT WILL BE REQUIRED IN THE EVENT OF WATERCOURSE BEING CONSTITUTED AND SET APART FOR DISCHARGE OF TAILINGS.
To the Minister of Mines, at Wellington.

Whereas by notice published in the Gazette on the day of , 19 , it is stated that application has been made to His Excellency the Governor to constitute and set aside by Proclamation the watercourse described in Table A hereunder to be a watercourse into which may be discharged tailings, débris, and waste water produced by or resulting from mining operations, and in which or on the banks of which mining operations may be carried on: And whereas by the operation of such Proclamation, if made, the lands described in Table B hereunder, in which I have an interest, as described in Table C hereunder, will be damaged or injuriously affected by reason that [Here state items of claim, with a reference number to each, and give in each case full particulars of the nature and extent of each such item]:

Now, therefore, this is to give notice that in the event of such Proclamation being made I shall claim £ , as compensation for all loss and damage arising from the operation thereof, which sum is made up as follows:—
[Here state reference number and short heading of each item of claim previously detailed, and the amount claimed in respect of each such item separately.]

Total claim ... ... £ s. d.

Given under my hand, at , this day of , 19 .
Claimant: [Christian name and surname in full.]
Address: [Address in full.]

TABLE A.
[Here describe the watercourse, as in the Gazette notice.]

TABLE B.
[Here describe the area and situation of the lands affected, giving name of survey district and number and block of section, or other means of identification.]

TABLE C.
[Here state in full the nature of the interest, as owner in fee-simple, mortgagee, lessee, or occupier; and if the lands are leased or encumbered, or subject to any easement, give particulars thereof.]

Form 62 (Reg. 90).
Under “The Mining Act, 1898.”
YEARLY RETURN TO BE MADE BY CLAIM-HOLDER.
To the Inspector of Mines for the Mining District.

NATURE of claim [State whether alluvial, sluicing, elevating, dredging, or quartz] :
Name of claim :
Area of claim :
Name of holder :
Name of mine-manager or dredge-master :
Name and address of legal manager or secretary :
Locality of mining operations :
Average number of men employed during the year :
Yield of gold for the year : oz. dwt. gr.