3286
THE NEW ZEALAND GAZETTE.
[No. 81

Form M.
Death Duties Act, 1909.
In the estate of

NOTICE OF ASSESSMENT OF DEATH DUTIES pursuant to Section 34 of the above Act.
I HEREBY give you notice that I have this day assessed the estate of the above deceased for death duties at £
, as per particulars set out below.
Dated this day of , 191 .
To the administrator of the estate of the above deceased.
Deputy Commissioner of Stamps.

Assessment of Estate Duty.
Final balance of estate .. .. .. .. .. .. .. .. £
Less exemption under section 12 .. .. .. .. .. .. £
Less exemption under section 13 .. .. .. .. .. ..

Amount dutiable .. .. .. .. .. .. .. .. £
Duty on £ , at per cent. .. .. .. .. .. .. .. .. £
Less balance gift duty as per Twenty-seventh Schedule not fully deducted from succession duty £

Estate duty payable .. .. .. .. .. .. .. .. £

Assessment of Succession Duty.
Sum of succession of wife, child, grandchild, and other descendants .. .. £
Less exemption under section 16 .. .. .. .. .. ..

Duty on such succession at two per cent. on £ .. .. .. .. £
Duty on succession of husband at per cent. on £ .. .. .. ..
Duty on succession of other relatives at per cent. on £ .. .. .. ..
Duty on succession of strangers at per cent. on £ .. .. .. ..

Total .. .. .. .. .. .. .. .. £

Succession duty as above .. .. .. .. .. .. .. .. £
Less gift duty paid as per Twenty-seventh Schedule on any specified succession .. £

Succession duty payable .. .. .. .. .. .. .. .. £

Summary of Death Duties.
Estate duty as above .. .. .. .. .. .. .. .. £
Succession duty as above .. .. .. .. .. .. .. .. £

Total duties payable .. .. .. .. .. .. .. .. £

Receipt.
Received from the sum of for duty assessed as above.
Stamp Office, , New Zealand, 191 .
Deputy Commissioner of Stamps.

Form N.
Death Duties Act, 1909, Part IV.
STATEMENT to be delivered to the Commissioner of Stamps by Donor within One Month (or by Beneficiary or Trustee within Fourteen Days after Default by Donor so to do) after the Making of any Gift subject to Gift Duty, pursuant to Sections 52 and 54 of the above Act.
Register . No. . 191 . Folio .
Date of gift :
Name of donor :
Name of beneficiary :
Name of solicitor (if any) filing statement :
Address for service :

Declaration.
I, , the above-named donor [or beneficiary], do solemnly and sincerely declare :—

1. That the statement hereunder written contains true and full particulars of all property both real and personal comprised in the gift of the above-mentioned date made by the above-named donor to the above-named beneficiary ; and also of all property both real and personal comprised in any gift upon which no duty has been paid made by the above-named donor to the above-named beneficiary within the space of six months from the said date.
2. That the value of the property set forth in such particulars is to the best of my knowledge and belief the true and full value of the said property as at the time of the making of the gift of such property.