1040
THE NEW ZEALAND GAZETTE.
[No. 3

No. 73.

New Zealand.
“ The Magistrates’ Courts
Act, 1908.”
ORDER OF REFERENCE.

In the Magistrate’s Court, held at
Between
and
, plaintiff,
, defendant.

By the consent of the plaintiff and defendant, it is ordered that this action, and other matters within
the jurisdiction of this Court in dispute between the said parties—that is to say, [Here specify them]
—be referred to
, of
, and to
, of
, as arbitrators, and to
of
, as umpire [or the said arbitrators to choose their own umpire], whose award, to be made
or given on or before the
day of
, 191 [Not more than one month from date], shall be
entered as the judgment in this action. And in case either of the said parties neglects or refuses
to attend any appointment to be made by the said arbitrators for proceeding under this order after
two days’ notice thereof in writing has been given to him, by serving the same personally or
by leaving it at his last or usual place of abode, the said arbitrators shall be at liberty to proceed ex
parte on the matters of the said reference, and their [or his] certificate shall be as valid as if both the
said parties had attended before them [or him]; and it is further ordered that the costs of this refer-
ence shall be paid by
, to abide the event of the action.
Dated at
, this
day of
, 191 .
(L.S.)
By the Court.

Stipendiary Magistrate.

No. 74.

New Zealand.
“ The Magistrate’s Courts
Act, 1908.”
AFFIDAVIT WHEN PLAINTIFF in forma pauperis.

In the Magistrate’s Court, held at
Between
and
, plaintiff,
, defendant.

I,
, of
, make oath and say: (1) That I,
, the above-named plaintiff, have
a meritorious cause of action; (2) I am unable by reason of poverty to pay the prescribed fees of
Court.

Sworn at
, this
day of
, 191 .
Before me
Justice of the Peace [or Clerk of Court, or Solicitor].

Plaintiff.

No. 75.

New Zealand.
“ The Magistrates’ Courts
Act, 1908.”
CONSENT TO ACT BY GUARDIAN ad litem.

In the Magistrate’s Court, held at
Between
and
, plaintiff,
, defendant.

I,
, of
, [Calling], consent to be appointed and to act as guardian ad litem to the
defendant in this action, who is an infant [and to be responsible for costs (if so ordered by Court)].

Dated at
, this
day of
, 191 .
Witness to signature:
Clerk of Court [or Justice of the Peace, or Solicitor].

(Signed.)

No. 76.

New Zealand.
“ The Magistrates’ Courts
Act, 1908.”
UNDERTAKING BY NEXT FRIEND OF INFANT TO BE
RESPONSIBLE FOR COSTS.

In the Magistrate’s Court, held at
Between
and
, plaintiff,
, defendant.

I, THE undersigned,
, of
, [Occupation], being the next friend of
, an infant,
the plaintiff [or the claimant in an interpleader proceeding] in this action, hereby undertake to be re-
sponsible for the costs of the defendant [or plaintiff] in the manner following, viz.: If the said plaintiff
fails to pay to the defendant [or plaintiff] when and in such manner as the Court orders, all such
costs of such action as the Court directs him to pay to the said defendant [or plaintiff], I will
forthwith, after notice of such default, pay the same to the Clerk of the Court.
Dated at
, this
day of
, 191 .
Witness to signature:
, Clerk of the Court.

Next friend of plaintiff [or claimant].

No. 77.

New Zealand.
“ The Magistrates’ Courts
Act, 1908.”
BAILIFF’S NOTICE OF CLAIM TO GOODS TAKEN IN EXECUTION.

In the Magistrate’s Court, held at
Between
and
, plaintiff,
, defendant.

TAKE notice that
, of
, [and calling], has claimed the goods [or certain goods enu-
merated in the list attached hereto] taken in execution by me under the warrant of distress issued
in this action. If you admit the title of the said
to the said goods, give notice thereof to
me by return of post or otherwise, with a view of saving further costs.
Dated at
, this
day of
, 191 .

Bailiff of the Court,

To the Execution Creditor.