1174
THE NEW ZEALAND GAZETTE.
[No. 52

Total value of gold: £
Value of gold per ounce: £
[In the case of a quartz claim] Quantity of material operated on during the year:
Mode of treatment:
[In the case of a registered company] Amount paid in dividends—
For the year: £
Since commencing work: £
A true return for the year ending the last day of December, 19
Dated at , this day of January, 19
Owner [or Manager].

Form 63 (Reg. 91).

Under “The Mining Act, 1898.”

BANK’S OR OTHER GOLD-BUYER’S YEARLY RETURN OF GOLD PURCHASED.

YEARLY return of gold purchased by [Naming the bank or other gold-buyer] at for the year ending on the last day of December, 19 :—

A true return.
Dated at , this day of January, 19
[Signature of bank-officer or gold-buyer.]

Form 64 (Reg. 92).

Under “The Mining Act, 1898.”

APPLICATION FOR DUPLICATE OF LOST OR DESTROYED DOCUMENT.

To the Warden of the Mining District,
at
I, THE undersigned [Full name, residence, and occupation], being the lawful holder of the license [or other document] specified in the Schedule hereto, hereby apply for the issue of a duplicate thereof on the ground that the original has been lost or destroyed; and in support of this application I do hereby solemnly and sincerely declare as follows:—

1. I am the lawful holder of the document above referred to, and it was lost [or destroyed] under the following circumstances: [Set out as far as known the date on which and the manner in which the loss or destruction occurred].
2. I have made diligent search for the said document, but have been unable to find it.
3. I have not, nor with my knowledge or consent has any other person, deposited the said document with any person for purposes of security or otherwise, and I verily believe it to be lost [or destroyed].
   And I make this solemn declaration conscientiously believing the same to be true, and by virtue of the provisions of “The Justices of the Peace Act, 1882.”

SCHEDULE.
[Set out the name of the document, the Act under which it was issued, the registration or other number, and such other particulars as will suffice to identify it.]

Declared by the said ; at , this day of , 19 , before me— , J.P.
[Solicitor, or other person authorised to take statutory declarations].

Form 65 (Reg. 96).

Under “The Mining Act, 1898.”

APPLICATION FOR A SAWMILL LICENSE.

[As in Form 15, with all necessary modifications, including Schedule, as follows.]

SCHEDULE.
Area, situation, and boundaries of land:
Proposed term of license:
[Signature of applicant, &c.]
Precise time, &c.

Form 66 (Reg. 96).

Under “The Mining Act, 1898.”

LICENSE FOR A SAWMILL.

PURSUANT to “The Mining Act, 1898,” I, the undersigned , a Warden of the Mining District, at , do hereby grant to [Full name, residence, and occupation], this license for a sawmill in respect of the land specified in the First Schedule hereto.
This license is granted for a term of years, commencing on the date hereof, subject to the respective rent, royalties, terms, conditions, reservations, and provisions set out in the aforesaid Act and the regulations thereunder, and also to such additional terms, conditions, reservations, and provisions as are specified in the Third Schedule hereto.
The annual rental is £ , being at the rate of 1s. per acre per annum.
All rent has been duly paid up to the last day of June [or December] next following the date hereof, and the subsequent payments of rent are to be made by equal half-yearly instalments in advance, the first half-yearly instalment in advance being due and payable on the last day of June [or December] aforesaid.
The royalties are specified in the Second Schedule hereto, and are payable on the same days as the rent accruing due after the date hereof, and for similar periods:
Provided that the first payment of royalty shall be due and payable on the same day as the first half-yearly instalment of rent, and be in respect of royalty for the period elapsing between the date of this license and such day:
Provided further that all sums paid in respect of royalty for any period shall, to the extent of the rent payable for such period, be deemed to be in or towards satisfaction of such rent.
In witness whereof I have hereunto subscribed my name, and affixed the seal of the Warden’s Court, at , this day of , 19 .

FIRST SCHEDULE.
[Set out area, situation, and boundaries of the land, and, if land is surveyed, affix plan.]

SECOND SCHEDULE.
ROYALTIES.
[Set out from Fourth Schedule to these Regulations.]

THIRD SCHEDULE.
[Set out additional terms, &c., if any.]
, Warden.

Form 67 (Reg. 97).

Under “The Mining Act, 1898.”

APPLICATION FOR CERTIFICATE OF RESERVATION OF TIMBER AREAS.

To the Warden of the Mining District,
at
PURSUANT to “The Mining Act, 1898,” the undersigned [Full name, residence, and occupation], being the holder of [or applicant for] a license for a sawmill in respect of the land specified in the First