Nov. 21. THE NEW ZEALAND GAZETTE. 2243

Instalments by which such capital value (with interest thereon) is payable,
and the due dates of such instalments:
By half-yearly instalments of each, in advance, in
respect of interest alone, and then half-yearly instalments of
each, in advance, in respect of combined capital and interest,
the first instalment (being for the half-year commencing on the first
day of , one thousand ) having been duly paid, and
the subsequent instalments being payable on the first day of
and the first day of in each year in the same manner as rent.

The Third Schedule hereinbefore referred to.
Improvements now existing on the demised land, and their value:

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 behalf of the lessor,}
in the presence of—
Signed by the above-named as}
lessee, in the presence of—

FOURTH SCHEDULE.
APPLICATION for Pastoral Land for Lease as Small Grazing-run under “The
Land for Settlements Consolidation Act, 1900,” and its Amendments.
To the Commissioner of Crown Lands for the Land District of .
I HEREBY apply for a lease of an allotment as a small grazing-run in
group or subdivision of the Settlement, and I deposit
herewith the sum of £ , being the half-year’s rent in one of the allot-
ments in group or subdivision , and I desire to select Run No. .
In proof of my fitness and qualifications to hold the land applied for, I
hereby make the following replies to the under-mentioned questions:—

Question. Answer.

1. How old were you last birthday? .. ..
2. What means (including stock and implements or
   machinery) do you possess for stocking and culti-
   vating the land, and erecting suitable buildings
   thereon; and what is the total value thereof?
3. Have you means sufficient, in your estimation, to
   enable you to profitably work the land and fulfil
   the conditions of the lease? If not, state how
   you propose to do so.
4. What experience have you had in working a run?
5. What is your present occupation? .. ..
6. Are you married? If so, has your wife (or husband)
   had any experience in working a run? Give
   particulars.
7. Have you any family? If so, state the number and
   sex of your children now living with you, and
   their ages.
8. What land do you hold or have an interest in?
   Give particulars of the number of block, section,
   area, and value of such land, and say whether it
   is freehold, leasehold, or what other tenure,
   specifying also what portion of it (if any) is
   rural and what portion (if any) is town or sub-
   urban land.
9. What land does your wife (or husband) hold, or have
   an interest in? Give particulars as above.
10. Is the rural land (if any) mentioned in answers 8
    and 9 insufficient for the maintenance of yourself
    and your family? If so, give your reasons.
11. Is the town or suburban land (if any) mentioned in
    answers 8 and 9 insufficient for a home for your-
    self and your family? If so, give your reasons.

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 Consolidation Act, 1900,” and its amendments, and the regula-
   tions made thereunder respectively, am applying for the small grazing-run
   described in the foregoing application [or for one of the small grazing-runs in
   the said group or subdivision].
3. That I am acquiring such run 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 Consolidation Act, 1900,” 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 run included in the foregoing application would exceed
   acres.