Mär. 21.] THE NEW ZEALAND GAZETTE. 885
And I make this solemn declaration conscientiously believing the same to be true, and by virtue of "The Justices of the Peace Act, 1908."
Declared at , in the Dominion of New Zealand, this day of , one thousand nine hundred and , before me, , a Justice of the Peace in and for the said Dominion.
(Signature.)
Form No. 31.—Reg. 27.
NEW ZEALAND.
"Friendly Societies Act, 1909."
ACKNOWLEDGMENT OF REGISTRY OF INSTRUMENT OF DISSOLUTION.
Name of society [and Name and No., if any, of branch]: Register No. of society:
THE foregoing instrument of dissolution [or alteration of the instrument of dissolution] of the Society [or branch] is registered under "The Friendly Societies Act, 1909," this day of , 19 .
(Seal or stamp and signature of Registrar.)
Form No. 32.—Reg. 29.
NEW ZEALAND.
"Friendly Societies Act, 1909."
ADVERTISEMENT OF DISSOLUTION BY INSTRUMENT.
NOTICE is hereby given that the branch of the Society, Register No. , held at , is dissolved by instrument, registered at this office the day of , 19 , unless, within three months from the date of the Gazette in which this advertisement appears, proceedings be commenced by a member or other person interested in or having a claim on the funds of the society [or branch] to set aside such dissolution, and the same be set aside accordingly.
Friendly Societies Office,
day of , 19 .
Form No. 33.—Reg. 30.
NEW ZEALAND.
"Friendly Societies Act, 1909."
AWARD FOR DISTRIBUTION OF FUNDS.
Name of society: Register No.:
PURSUANT to section 65 of the above-mentioned Act, and to the instrument of dissolution of the same, registered on the day of , 19 , I hereby award and direct that the assets of the society shall be divided and appropriated in the following manner:—
Friendly Societies Office,
day of , 19 .
Form No. 34.—Reg. 31.
NEW ZEALAND.
"Friendly Societies Act, 1909."
APPLICATION TO REGISTRAR FOR AWARD OF DISSOLUTION OF SOCIETY.
Name of society: Register No.:
APPLICATION for an award of dissolution of the above-mentioned society is made by the members whose names are subscribed at the foot hereof.

1. The society consists of _ members, one-fifth of the whole number of whom [or 100 or more of whom if the society has 500 members and not exceeding 10,000, or 500 or more of whom if the society has more than 10,000 members] have signed this application.
   2.[The funds of the society are insufficient to meet the existing claims thereon [or the rates of contribution fixed in the rules of the society are insufficient to cover the benefits assured].
2. The grounds upon which such insufficiency is alleged are as follow [State grounds].
3. The Registrar is hereby requested to make or cause to be made, pursuant to "The Friendly Societies Act, 1909," section 67, an investigation into the affairs of the society, with a view to the dissolution thereof.
4. It is desired that notice of the award of dissolution be published in the [Naming some newspaper], circulating in the city [town or district] in which the registered office of the society is situated.
5. The sum of , to cover the cost of publishing such notice in the said newspaper and in the Gazette, is herewith transmitted.
   (Signatures of members.)
   Registered office : Date: day of , 19 .
   Form No. 35.—Reg. 31.
   NEW ZEALAND.
   "Friendly Societies Act, 1909."
   NOTICE OF INVESTIGATION.
   Name of society:
   Register No. :
   NOTICE is hereby given that the Registrar will proceed, by himself [or by (Name of), Actuary, whom the Registrar hereby appoints for the purpose], to investigate the affairs of the above-mentioned society, in compliance with an application in that behalf made pursuant to section 67 of the abovementioned Act, on , the day of , 19 [Two months at least after the date of the notice], at o'clock, at , and he hereby directs that in the event of an award of dissolution being made, the date of the said investigation shall be the date at which all contributions and benefits shall cease.
   , Registrar.
   To , of .
   Date: day of , 19 .
   (To be addressed to the society at its registered office.)
   Form No. 36.—Reg. 33.
   NEW ZEALAND.
   "Friendly Societies Act, 1909." Section 67 (3).
   AWARD OF DISSOLUTION.
   Name of society:
   Register No. :
   PURSUANT to section 67 of the above-mentioned Act, I hereby award that the shall be dissolved and its affairs wound up as from the day of , 19; and I direct that the assets of the said society shall be divided and appropriated in the following manner:—
   , Registrar.
   To , of .
   Date: day of , 19 .
   Form No. 37.—Reg. 34.
   NEW ZEALAND.
   "Friendly Societies Act, 1909." Section 67 (6).
   NOTICE OF DISSOLUTION BY AWARD.
   NOTICE is hereby given that, on the day of , 19 , the Registrar signed an award for the dissolution of the Society, Register No. , held at , and that such society is thereby dissolved, unless, within three months from the date of the Gazette in which this advertisement appears, proceedings be commenced by a member or other person interested in or having any claim on the funds of the society to set aside such dissolution, and the same be set aside accordingly.
   , Registrar.
   Friendly Societies Office,
   day of , 19 _.