666
THE NEW ZEALAND GAZETTE.
[No. 16

at
, within the Mining District, and at no
other place, until the 31st day of December, 190
, and no
longer.

Given under my hand, at Wellington, this day
of
, 190
.
, Minister of Mines.

Entered in the Register of Licensed Gold-dealers.
, Registrar.

Form 110 (Reg. 177).

GOLD-DEALER’S LICENSE FOR INCORPORATED BANK.

I,
, Minister of Mines, by virtue of the powers con-
ferred upon me by section 47 of “The Mining Act Amend-
ment Act, 1905,” and the regulations, do hereby grant
to
, an incorporated bank carrying on business at its
head office at
, a license to deal in gold at the
branches described on the back hereof, under the provisions
of the said Act and regulations, until the 31st day of
December, 190
, and no longer.

Given under my hand, at Wellington, this day of
, 190
.
, Minister of Mines.

Entered in the Register of Licensed Gold-dealers.
, Registrar.

List of places where such Branches of the Bank are esta-
blished, and Names of Present Managers thereof.

Form 111 (Reg. 181).

GOLD-DEALER’S BOOK.

• Under this heading particulars must be stated as to whether the
  transaction was a sale, purchase, advance, or deposit for safe keep-
  ing.

† Under this heading must be accurately set out the particulars of
the gold dealt with, in accordance with the definition thereof con-
tained in section 40 of “The Mining Act Amendment Act, 1905.”

Form 112 (Reg. 182).

RETURN OF GOLD BOUGHT OR SOLD BY AN INCORPORATED
BANK OR LICENSED GOLD-DEALER FOR THE MONTH
OF
, 190
.

(To be posted to the Under-Secretary for Mines not later
than the 5th day of each month.)

• Under this heading particulars must be stated as to whether the
  transaction was a sale, purchase, advance, or deposit for safe keep-
  ing.

† Under this heading must be accurately set out the particulars of
the gold dealt with, in accordance with the definition thereof con-
tained in section 40 of “The Mining Act Amendment Act, 1905.”

I,
, manager of the Bank at [or a
licensed gold-dealer, whose registered address for business
is at
], do hereby certify that the foregoing is a true
and correct statement of all the transactions of my bank
[or of all my transactions] in gold during the month ending
, 190
.

Signature of licensee :
.
Address and description :
.
Date :
.

To the Under-Secretary for Mines, Wellington.

Form 113 (Reg. 183).

DECLARATION AS TO GOLD* SENT BY POST OR OTHERWISE.

I,
, of
, do solemnly and sincerely declare
as follows :—

1. I did on the day of
   , 190
   , forward to
   the Bank at by post a parcel containing
   [Here set out nature of contents and approximate quantity or
   weight thereof].

2. The said is my property [or the property of
   , of
   ], and was acquired by me [or him]
   [Here set out whether it was acquired by purchase or is the
   product of some mining lease, and in the former case the name
   and address of the seller, and in the latter case the name and
   situation of the lease and the holder thereof].

And I make this solemn declaration conscientiously
believing the same to be true, and by virtue of the provisions
of an Act of the General Assembly of New Zealand intituled
“The Justices of the Peace Act, 1882.”

Declared at
, this day of one
thousand nine hundred and
, before me—
Warden, Mining Registrar, Magistrate, Justice of the Peace,
Postmaster, or Constable.

• “Gold” includes gold, gold bullion, retorted gold, gold-ores,
  gold-amalgam, gold-alloys, precipitates containing gold, slag, con-
  centrates, tailings, and residues, but does not include coin or
  things manufactured of gold.

[To be forwarded to the Bank.]

Form 114 (Reg. 184).

APPLICATION FOR A TEMPORARY GOLD-DEALER’S LICENSE.

To the Warden of the Mining District at
.

I,
, of
, do hereby make application, in ac-
cordance with the provisions of section 57 of “The Mining
Act Amendment Act, 1905,” for a temporary license to deal
in gold. My present address for carrying on business is at
, in the said mining district. I have [not] pre-
viously held a license for such purpose.

Dated this day of
, 190
.
Signature of applicant :
.

Received this application at o’clock .m. on the
day of
, 190
, with a fee of five shillings.
, Warden.

Form 115 (Reg. 185).

TEMPORARY GOLD-DEALER’S LICENSE.

I,
being the Warden of the Mining Dis-
trict, do, by virtue of the powers vested in me under sec-
tion 57 of “The Mining Act Amendment Act, 1905,” grant
to
a temporary gold-dealer’s license to deal in gold
at
, in the said mining district, and at no other
place, for a period of month from the day of the
date hereof, and no longer.

Given under my hand, at
, this day
of
, one thousand nine hundred and
.
, Warden,