884

THE NEW ZEALAND GAZETTE.

No. 25

Form No. 29.-Reg. 26.
NEW ZEALAND.
"Friendly Societies Act, 1909."
INSTRUMENT OF DISSOLUTION OF BRANCH.
Name of society:
Register No. :
Name and No., if any, of branch:
INSTRUMENT of dissolution of the , made the
day of , 19 , pursuant to "The Friendly Societies
Act, 1909," and signed by five-sixths in value of the mem-
bers, including honorary members, if any, and by every
person for the time being receiving or entitled to receive any
relief, annuity, or other benefit from the funds of the society
[except , whose claims have been duly satisfied or
have been provided for (State in what manner such provision
has been made)].
It is agreed and declared as follows :—

1. The liabilities and assets of the branch are the following
   [Here set them forth in detail].
2. The number of members is , and the nature of
   their interests in the branch respectively is as follows [Specify
   nature of benefits, &c.].
3. The branch has no creditors other than such members
   [or if there be any, state the amount due to them and the pro-
   vision to be made for its payment].
4. The funds and property of the branch shall be appro-
   priated and divided in the following manner [or in such
   manner as the Registrar may award].
   [Here insert any other provisions the branch desires to make
   as to the dissolution.]
   Signatures of Members.
   No. of Votes
   of each
   Member.
   Signatures of Persons receiving or entitled to receive any
   Relief, Annuity, or other Benefit from the Funds of the
   Branch.*
   Date: day of , 19 .
   (Schedule.)
   List of Members who have not signed the foregoing
   Instrument.
   No. of Votes
   of each
   Member.
   The consent of the central body of the society has been
   given to the dissolution.
   (Signature of secretary
   of the society.)
   Date: day of , 19 .
   N.B.—All signatures by mark only must be attested by a
   witness who does not sign as a member.

• These consents may be given separately.
  Form No. 30.-Reg. 26.
  NEW ZEALAND.
  "Friendly Societies Act, 1909."
  DECLARATION TO ACCOMPANY INSTRUMENT OF
  DISSOLUTION.
  Name of society [and Name and No., if any, of branch]:
  Register No. of society:
  I, , of , one of the trustees of the above-
  named society [or branch], do solemnly and sincerely declare
  that, in making the instrument of dissolution [or the altera-
  tion of the instrument of dissolution] appended to this dec-
  laration the provisions of "The Friendly Societies Act, 1909,"'
  have been complied with.

1. The above-named society desires to amalgamate with
   [or transfer all its engagements to] the Society,
   Register No.
2. The trustees [or committee of management] of the first-
   named society hereby apply to the Registrar that the follow-
   ing consents and conditions prescribed by the Friendly
   Societies Act for an amalgamation or transfer of engage-
   ments may be dispensed with—namely [State what consents
   and conditions].
3. Notice of the intention to make the present application
   was advertised in the Gazette on the day of
   being one calendar month previous to the date of this appli-
   cation, and a copy of the Gazette in which such notice appears
   is sent herewith.
   , ) Trustees [or members of the
   .1 committee of management].
   Date: day of , 19 .
   Form No. 28.-Reg. 26.
   NEW ZEALAND.
   "Friendly Societies Act, 1909."
   INSTRUMENT OF DISSOLUTION.
   Name of society:
   Register No. :
   INSTRUMENTS of dissolution of the , made the
   day of , 19 , pursuant to "The Friendly Societies
   Act, 1909," section 65, and signed by [in the case of a society
   not a friendly society three-fourths of the members, but in the
   case of a friendly society five-sixths in value] of the members,
   including honorary members, if any, and by every person
   for the time being receiving or entitled to receive any relief,
   annuity, or other benefit from the funds of the society [except
   , whose claims have been duly satisfied or have been
   provided for (State in what manner such provision has been
   made)].
   It is agreed and declared as follows :—
4. The liabilities and assets of the society are the following
   [Here set them forth in detail].
5. The number of members is , and the nature of
   their interests in the society respectively is as follows [Specify
   nature of benefits, &c.].
6. The society has no creditors other than such members
   [or if there be any, state the amount due to them and the pro-
   vision to be made for its payment].
7. The funds and property of the society shall be appro-
   priated and divided in the following manner [or in such
   manner as the Registrar may award].
   [Here insert any other provisions the society desires to make
   as to the dissolution.]
   Signatures of Members.
   No. of Votes
   of each
   Member.
   Signatures of Persons receiving or entitled to receive any
   Relief, Annuity, or other Benefit from the Funds of the
   Society.*
   Date: day of , 19 .
   (Schedule.)
   List of Members who have not signed the foregoing
   Instrument.
   No. of Votes
   of each
   Member.
   N.B.—All signatures by mark only must be attested by a
   witness who does not sign as a member.

• These consents may be given separately.