510
THE NEW ZEALAND GAZETTE.
[No. 12

The amount of the pension is ascertained thus:—
Maximum amount of pension .. .. .. £18
Less deductions as under:—
Income for first income-year .. .. £
Less allowance by Act .. .. £34
Deduction on account of income .. £
—— £
Gross value of accumulated property .. £
Less property transferred to Public Trustee .. .. .. £
Less allowance by Act .. .. £50
Net value of accumulated property .. £
Deduction on account of property, being £1 for every complete £15 thereof .. £
——
Amount of pension .. .. .. £

Dated at , this day of , 19 .
, Stipendiary Magistrate.

THE PUBLIC TRUSTEE, WELLINGTON.

I forward herewith Magistrate’s Certificate in connection with the application for pension herein. When the transfer or conveyance of the property has been executed in terms of section 8 of “The Old-age Pensions Act Amendment Act, 1902,” and the deeds are in your possession, please return this form to me.

Date: , Registrar, Old-age Pensions.

THE REGISTRAR, OLD-AGE PENSIONS.

The property referred to has been transferred [or conveyed] as required, and the deeds are in my possession.

Date: , Public Trustee.

—

Form 2 (Reg. 3).

PENSION-CLAIM REGISTER.

—

Form 3 (Reg. 4).

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

NOTICE OF INFORMAL CLAIM.

To .

Your pension-claim is returned herewith, as it is not made on the printed form as prescribed by the regulations. For your convenience I enclose a printed form.

Dated at , this day of , 19 .
, Deputy Registrar for the Old-age Pension District.

—

Form 3A (Reg. 4).

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

NOTICE TO CLAIMANT.

To .

Your pension-claim has been forwarded to me instead of to the Deputy Registrar of the Old-age Pension District, being the district in which it appears from your claim that you reside: I have therefore forwarded it to him.

Dated at , this day of , 19 .
, Deputy Registrar for the Old-age Pension District.

Form 4 (Reg. 7).

Under the Old-age Pensions Acts, 1898, 1900, 1901, 1902.

NOTICE TO CLAIMANT TO ATTEND ON INVESTIGATION OF PENSION-CLAIM [or, as the case may be, of INCOME AND PROPERTY STATEMENT.]

To .

Take notice that the investigation of your pension-claim (No. ) [or, as the case may be, your income and property statement] will be made on day, the day of , 19 , at the Courthouse at , at o’clock in the noon, and that you may then and there attend in support thereof by the production of papers or other evidence.

If good and sufficient reason is not given for your non-attendance on the date herein mentioned your claim will be rejected, and in the case of the application being for renewal your name will be struck off the pension-roll.

Dated at , this day of , 19 .
, Clerk of the Court at .

—

Form 5 (Reg. 9).

“The Old-age Pensions Act, 1898.”

MEMORANDUM.

To the Deputy Registrar, Old-age Pension District.
In re Pension claim No. , made by .

The Stipendiary Magistrate’s decision is that the above claim is rejected on the following grounds:

The following material points have been proved:

Dated at , this day of , 19 .
, Clerk of Court.

[The contents of this form are to be noted in the Pension-claim Register, and the form forwarded to the Registrar at Wellington.]

—

Form 6 (Reg. 10).

Pension-certificate No. .

Under the Old-age Pensions Acts, 1898, 1900, 1901, 1902.

STIPENDIARY MAGISTRATE’S CERTIFICATE OF ESTABLISHMENT OF PENSION-CLAIM.

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

I HEREBY certify that the pension-claim (No. ) made by , [Occupation], of [Address], has been this day established before me, and you are hereby authorised to issue a pension-certificate for one year’s pension of £ , payable in equal monthly instalments of £ , at the Post-Office Money-order Office. The pension-year commences on the 1st day of the calendar month next after the date of the issue of this certificate, and the first instalment is due on the 1st day of the calendar month next after the commencement of the pension-year.

The income-year ends on the day of , 19 , and on the same day in each subsequent year.

The applicant’s income was .. £
The applicant’s husband’s [or wife’s] income was .. £

Deduction on account of income, being amount in excess of £34, £ .
The gross value of applicant’s property is .. £
Less allowance by Act .. .. £50
Less encumbrances, &c. .. .. £
—— £
Making the net value of property .. .. £

The gross value of applicant’s husband’s [or wife’s] property is .. .. .. .. £
Less allowance by Act .. .. .. £50
Less encumbrances, &c. .. .. .. £
—— £
Making the net value of property .. .. £

Deduction on account of property, being £1 for every £15 in net value, £ .

Dated at , this day of , 19 .
, Stipendiary Magistrate.
Pension-certificate No. issued to Deputy Registrar, , 19 .