Oct. 28.]

hereto, which has been duly marked out for the purpose,
and is portion of the mining privilege specified in that
Schedule.

The works to be constructed and the rights to be exercised
able under the certificate of easement are as specified in the
Second Schedule hereto.

Address for service:
Dated at , this day of , 19 .

FIRST SCHEDULE.

[Specify the land with reasonable particularity, as also the
name, locality, registered number (if any), and holder of the
mining privilege in which such land is comprised.]

SECOND SCHEDULE.

[Specify with reasonable particularity the works to be con-
structed and the rights to be exercised under the certificate.]

[Signature of applicant, &c.]

Precise time of filing application, &c.
Time and place, &c.

Form 27 (Reg. 33).

Under “The Mining Act, 1908.”

OBJECTION TO AN APPLICATION.

In the matter of an application numbered in the
Application Record-book, at , for [Here state nature
of application to which objection is made].

THE undersigned [Full name, residence, and occupation]
hereby gives notice that he objects to the granting of the
above-described application, and the following are the grounds
of his objection, namely,—

[Here set out grounds of objection clearly, concisely, and in
consecutive paragraphs.]

Address for service:
Dated at , this day of , 19 .

[Signature of objector, &c.]

Form 28 (Reg. 33).

Under “The Mining Act, 1908.”

DECLARATION WHERE APPLICANT DOES NOT DESIRE TO
APPEAR.

In the matter of an application numbered in the
Application Record-book at , for [State subject-
matter of application].

I, A. B. [Full name, residence, and occupation], do hereby
solemnly and sincerely declare as follows :—

1. That I am the applicant [or one of the applicants]
   named in the above-described application.

2. That all the statements contained in the application are
   true.

3. That all prescribed provisions as to marking out the
   ground referred to in the application, posting notices thereon,
   serving notices on all persons affected, and otherwise, have
   been duly observed, in so far as is required by law.

4. That the ground applied for does not cross any road or
   street, and is Crown land open for mining within the meaning
   of “The Mining Act, 1908.”

5. That I believe myself [or the applicants] to be entitled
   to the grant of the application, and know of no valid objec-
   tion thereto.

6. That, so far as I am aware, no public or private rights
   will be prejudicially affected by the grant of the application.

7. [Here set out such other facts as may be necessary.]

And I make this solemn declaration conscientiously be-
lieving the same to be true, under and by virtue of the pro-
visions of an Act of the General Assembly of New Zealand
intituled “The Justices of the Peace Act, 1908.”

Declared at , this day of , 19 ,
before me— , a Justice of the Peace for the Dominion
of New Zealand [or as the case may be].

Form 29 (Reg. 33).

Under “The Mining Act, 1908.”

LICENSE FOR A CLAIM OTHER THAN AN ORDINARY CLAIM.

PURSUANT to “The Mining Act, 1908,” I, the undersigned,
, a Warden of the Mining District, do hereby
grant to [Full name, residence, and occupation] this license
for [Set out class and subdivision of claim—e.g., a Special
Dredging Claim, an Extended Quartz Claim, or otherwise,
as the case may be, not being an ordinary claim], in respect of
the land described in the First Schedule hereto.

This license is granted for a term of years, com-
mencing on the date hereof, subject to the payment of the
rent as specified in the Second Schedule hereto, and also to

the terms, conditions, reservations, and provisions set out
in the aforesaid Act and the regulations thereunder, and to
such additional terms, conditions, reservations, and provi-
sions as are specified in the Third Schedule hereto.

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.

All that area of land in the Mining District, con-
taining by admeasurement acres roods and
perches, more or less, situate [Here set out section,
block, survey district, boundaries, and measurements; and, if
land is surveyed, affix plan].

SECOND SCHEDULE.

1. A rental in respect of each acre or portion thereof at
   the rate of 2s. 6d. a year for the period elapsing between the
   date hereof and the last day of June [or December] ensuing
   after the expiration of one year from the date hereof, 5s. for
   the next succeeding year, and 7s. 6d. for each subsequent
   year during the term of the license: the amount of the rental
   being—for the first year, £ ; for the next succeeding
   year, £ ; and for each subsequent year, £ . In
   case of Native land, a rental in respect of each acre or portion
   thereof at the rate of ls. per annum, the amount of the rental
   for each year being £ .

2. All payments in respect of the aforesaid rent have been
   duly made up to the last day of June [or December] next
   following the date of this license, and the subsequent pay-
   ments are to be made by half-yearly instalments in advance,
   the first half-yearly instalment being due and payable in
   advance on the last day of June [or December] aforesaid.

THIRD SCHEDULE.

1. The right of the public to use all tracks over and across
   the land held under this license for so long and until proper
   roads are provided and open for public traffic is reserved.

2. The right to take all roads for public purposes which
   shall, in the opinion of the Warden, be necessary is reserved
   without any claim for compensation, except where such
   roads may interfere with workings actually in use; and the
   licensee shall also take out and hold in his own name a miner’s
   right relating to Native ceded land in respect of every person
   employed in mining on such area, whether on wages or as a
   tributer or as a contractor.

3. That the owner hereof will bona fide and continuously
   work the claim by carrying on mining operations for gold
   hereon with reasonable diligence and skill, and will commence
   such operations within from the date of this license.

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

, Warden.

Form 30 (Reg. 33).

Under “The Mining Act, 1908.”

LICENSE FOR AN ORDINARY CLAIM.

[As in Form 29, omitting all references to rent, and making
all other necessary modifications.]

Form 31 (Reg. 33).

Under “The Mining Act, 1908.”

LICENSE FOR A WATER-RACE.

PURSUANT to “The Mining Act, 1908,” I, the undersigned,
, a Warden of the Mining District, do
hereby grant to [Full name, residence, and occupation] this
license for a water-race, as specified in the First Schedule
hereto.

This license is granted for a term of years, com-
mencing on the date hereof, subject to the 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 speci-
fied in the Second Schedule hereto.

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 locality of race and nature of the proposed work as
set forth in application, modified, however, so as to accord with
the grant, adding such other particulars as are necessary, in-
cluding plan of land if surveyed, number of heads authorised
to be diverted, and purpose for which water is to be used.]

SECOND SCHEDULE.

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

, Warden.