Mar. 22.] THE NEW ZEALAND GAZETTE. 837

transfer, mortgage, or other disposition there shall also be
paid such stamp duty or registration fees as are prescribed
by "The Stamp Act, 1882," "The Land Transfer Act, 1885," and any amendments thereof respectively.

Every lease shall be prepared and executed in triplicate by
the Commissioner of Crown Lands on behalf of His Majesty
the King, and the lessee, in the form or to the effect set forth
in Form C in the Schedule hereto, and after such execution
shall be registered by the Commissioner under "The Land
Transfer Act, 1885," or any Act that may hereafter be passed
in lieu thereof, or in like manner, as nearly as may be, mutatis
mutandis, as a certificate of title is registered, and the lease
which is retained in the office of the District Land Registrar
shall form a folium of the register-book in such office, and on
it all dealings therewith shall be registered; but no fee shall
be payable by way of contribution to the assurance fund on
the registration of any such lease. Every certificate of title
issued in respect of the fee-simple of any dwelling under this
Act shall in like manner be registered under "The Land
Transfer Act, 1885," and shall be in the form or to the effect
set forth in Form D in the Schedule hereto. All dealings
with the dwelling comprised in any such lease or certificate of
title shall be made in accordance with the provisions of the
last-mentioned Acts, and be in all respects subject thereto;
but no transfer or other dealing with any lease or title shall
be valid unless all the conditions upon which the lease or title
was granted have been complied with up to the date of such
transfer or other dealing, and the consent of the Land Board
thereto shall have been obtained.

In respect of every weekly tenancy, the memorandum of
agreement shall be prepared in duplicate, and such agreement
shall be executed in duplicate by the Commissioner of Crown
Lands, on behalf of His Majesty the King and the tenant.
One copy of such agreement shall be retained for record in
the office of the Commissioner of Crown Lands, and the
other copy shall be handed to the tenant.

SCHEDULE.

Form A (Reg. 3).

NEW ZEALAND.

(Royal Arms.)

APPLICATION FOR A WORKER'S DWELLING UNDER "THE
WORKERS' DWELLINGS ACT, 1905," AND THE REGULATIONS THEREUNDER.

To the Land Board for the Land District of

I [Name in full], of [Address and occupation], hereby apply
for a worker's dwelling, Class , rooms, situated
on Allotment, &c., or Subdivision of
the Settlement. And I deposit herewith the sum
of £ , being rent of such dwelling.

I declare that this application is made subject to the provisions of "The Workers' Dwellings Act, 1905," and its
amendments, and the regulations for the time being in force
thereunder.

I declare my preference for dwelling No. , situated
on Allotment No. of Block .

I desire [or do not desire] to acquire the freehold of such
dwelling, and to do so in mode of section 10 of the
said Act.

Usual signature of applicant:

Address:

Occupation:

Declaration.

I [Name in full], of [Address and occupation], 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 Workers' Dwellings Act, 1905," and the regulations
   made thereunder respectively, am applying for a worker's
   dwelling of the Class, as described in the foregoing
   application.

3. That I am acquiring such dwelling solely for my own
   use or benefit (and that of my family), and not directly or
   indirectly for the use or benefit of any other person or persons
   whomsoever.

4. That I am employed in manual labour [or specify other
   work in which applicant is engaged], and am not in receipt of
   more than £156 pounds per annum.

5. That I am not directly or indirectly either by myself
   or jointly with any other person or persons the owner in fee-
   simple, or the tenant or occupier under a lease, of any land in
   New Zealand.

And I make this solemn declaration conscientiously believing
the same to be true, and by virtue of an Act of the General

Assembly of New Zealand intituled "The Justices of the
Peace Act, 1882."

Usual signature:

Declared at , this day of , one
thousand nine hundred and , before me—

Signature:

A Justice of the Peace in and for the
Colony of New Zealand [or as the
case may be].

Received on , at
, Commissioner of Crown Lands.

Form B (Reg. 35).

"The Workers' Dwellings Act, 1905."

AGREEMENT TO LEASE.

MEMORANDUM of agreement made and entered into this
day of , 19 , between His Majesty King Edward
the Seventh (who with his heirs and successors is hereinafter
referred to as "the lessor") of the one part and [Name of
lessee in full], of [Address], in the Land District of
, in the Colony of New Zealand, [Occupation] (who with his
executors, administrators, and permitted assigns is hereinafter
referred to as "the lessee") of the other part.

1. The said lessor agrees to let to the said lessee, and the
   said lessee agrees to take, the dwellinghouse with garden
   and other appurtenances thereto, known as Allotment
   , Class , situate and being in the Land District of
   , as the same is delineated upon the plan drawn
   hereon, and therein coloured red in outline: To hold the same
   as from the day of , 19 , upon a weekly
   tenancy, subject to the provisions of "The Workers' Dwell-
   ings Act, 1905," and the regulations at present in force there-
   under, and subject also to the terms and conditions herein set
   forth, namely:—

2. The rent for the said premises shall be the sum of
   shillings per week, payable weekly, on the day of
   each week, at the office of the Receiver of Land
   Revenue.

The first of such payments having been made, the next
to become due and be made on the day of
next.

3. The lessee shall not, nor will at any time during the
   said term, assign, underlet, or part with the possession of the
   said premises hereby demised, or any part thereof, without
   the consent in writing of the Land Board for the time being
   of the Land District of (acting on behalf of the
   lessor) first had and obtained.

4. The lessee will from time to time during the said term
   pay unto the lessor the said rent on the days and in the
   manner aforesaid.

5. With respect to the said premises the lessee will from
   time to time abide by and conform to all the by-laws and
   regulations from time to time in force or made or passed by
   the local authority for the time being intrusted under any
   Act with the administration of the local affairs in the said
   district, by whatever name or designation such local autho-
   rity may now or at any time hereafter be called.

6. The lessee will not, during the said term, sink any wells
   or make any excavations in or upon the said premises without
   the consent in writing of the Land Board first had and ob-
   tained.

7. The lessee will not at any time during the said term
   carry on or permit to be carried on upon the said premises
   or any part thereof the trade or business of a soap-boiler,
   tallow-chandler, tanner, slaughterman, meat curer or pre-
   server, or any noisy, noxious, or offensive trade or manu-
   ufacture of any kind whatever.

8. The lessee will permit the lessor, or any officer or person
   on his behalf duly authorised as hereinafter provided, from
   time to time to enter upon the said premises at all reasonable
   times to view the state and conditions thereof, and upon
   notice of any defect or want of repair being given to the lessee
   by any such officer or person aforesaid, or left for him on the
   premises, the lessee will, within the time specified in such
   notice, make good any such defect or want of repair.

9. The lessee will reside upon the said premises continu-
   ously as from the date of the commencement of the said
   tenancy:

Provided always that whenever the rent reserved shall
be in arrear for seven days the same may be levied by distress:
Provided further that if the rent hereby reserved, or any part
thereof, shall at any time during the said term be in arrear
and unpaid for the space of seven days next after any or
either of the days hereinbefore appointed for the payment
thereof, or if the lessee shall commit a breach of or fail to per-
form or observe any of the covenants, conditions, or agree-
ments on his part contained herein, then and in any such case
it shall be lawful for the lessor to re-enter upon the demised