2738
THE NEW ZEALAND GAZETTE.
[No. 89

Form 107 (Reg. 166).

FORM OF APPLICATION TO CANCEL REGISTRATION AS A MINING AGENT.

To the Warden of the Mining District at
and to , a Registered Mining Agent.

TAKE notice that I, the undersigned, intend to make application for the cancellation of the registration of the above-named as a mining agent under the above Act, on the grounds following: [Here set out the grounds of application with reasonable particularity, in separate paragraphs consecutively numbered].

Date and number of miner’s right:
Address for service:
Dated at , this day of , 19 .
, Objector.

Form 108 (Reg. 172).

APPLICATION FOR A GOLD-DEALER’S LICENSE.

To the Warden of the Mining District at .

I, , of , do hereby make application for a license under “The Mining Act, 1908,” to deal in gold. My present address for carrying on business is at , in the said mining district. I have [not] previously held a license for such purpose.

Dated at , this day of , 19 .
[Signature of Applicant.]

Address for business:

Received the within application at the hour of .m. on the day of , 19 , with a fee of 5s.
, Mining Registrar [or Clerk of the Court].

Form 109 (Reg. 176).

GOLD-DEALER’S LICENSE.

I, , Minister of Mines, being satisfied that is a fit and proper person to be a licensed gold-dealer, do hereby license the said to be a gold-dealer under the provisions of “The Mining Act, 1908,” and the regulations, to carry on the business of a gold-dealer at , in the premises occupied by him and situate at , within the Mining District, and at no other place, until the 31st day of December, 19 , and no longer.

Given under my hand, at Wellington, this day of , 19 .
, 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 conferred upon me by section 371 of “The Mining Act, 1908,” 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, 19 , and no longer.

Given under my hand, at Wellington, this day of , 19 .
, Minister of Mines.

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

List of Places where such Branches of the Bank are established, 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 keeping.

† Under this heading must be accurately set out the particulars of the gold dealt with, in accordance with the definition thereof contained in section 364 of “The Mining Act, 1908.”

Form 112 (Reg. 182).

RETURN OF GOLD BOUGHT OR SOLD BY AN INCORPORATED BANK OR LICENSED GOLD-DEALER FOR THE MONTH OF , 19 .

(To be posted to the Under-Secretary of 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 keeping.

† Under this heading must be accurately set out the particulars of the gold dealt with, in accordance with the definition thereof contained in section 364 of “The Mining Act, 1908.”

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 of 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, or by , 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, 1908.”