JUNE 8.] THE NEW ZEALAND GAZETTE 1883

of Trade-marks as proprietor[s] of the Trade-mark*No. in Class .
I am [or We are] entitled to the said trade-mark and to the goodwill of the business concerned in the goods with respect to which the said trade-mark is registered.
Accompanying this request is a statement of my [or our] case.
[Signature.]
Dated this day of , 19 .
To the Registrar, Patent Office, Wellington, New Zealand.

[Form No. 17.
The Patents, Designs, and Trade-marks Act, 1911.
FORM OF DECLARATION (TO BE FURNISHED ONLY WHEN REQUESTED BY REGISTRAR) IN SUPPORT OF STATEMENT OF CASE ACCOMPANYING .
I, , of , do hereby solemnly and sincerely declare that the particulars set out in the statement of case, exhibit marked , and left by me in connection with my request to be registered as subsequent proprietor of the Trade-mark No. in Class , are true, and comprise every material fact and document affecting the proprietorship of the said trade-mark as above claimed.
And I make this solemn declaration conscientiously believing the same to be true, and by virtue of the Justices of the Peace Act, 1908.
[Signature.]
Declared at , this day of , 19 , before me,—
[Signature and title of the authority before whom the declaration is made.]
To the Registrar, Patent Office, Wellington, New Zealand.

[Form No. 18.
Stamp, 5s.
(Leave uncanceled.)
The Patents, Designs, and Trade-marks Act, 1911.
NOTICE OF APPLICATION FOR ALTERATION OF ADDRESS ON REGISTER OF TRADE-MARKS.
In the matter of the Trade-mark No. registered in Class .
I, , of , the registered proprietor of the trade-mark numbered as above, desire that my address on the Register of Trade-marks be altered to .
Dated this day of , 19 .
[Signature.]
To the Registrar, Patent Office, Wellington, New Zealand.
If address altered in more than one case at same, time attach 5s. stamp for first and 1s. stamp for each of other marks.

[Form No. 19.
Stamp, £5.
(Leave uncanceled.)
The Patents, Designs, and Trade-marks Act, 1911.
APPLICATION TO PERMIT AN APPORTIONMENT OF TRADE-MARKS.
In the matter of the registered Trade-marks Nos. .
WE, being the parties interested within the meaning of section 78 of the Patents, Designs, and Trade-marks Act, 1911, in certain marks of , who has ceased to carry on business, request you to permit an apportionment of those marks amongst the persons in fact continuing the business. With this application we send a case in pursuance of Regulation No. 74 of the regulations under the said Act relating to trade-marks.
[Signatures.]
Dated this day of , 19 .
To the Registrar, Patent Office, Wellington, New Zealand.

[Form No. 20.
Stamp, 5s.
(Leave uncanceled.)
The Patents, Designs, and Trade-marks Act, 1911.
FORM OF REQUEST FOR CORRECTION OF CLERICAL ERROR OR FOR PERMISSION TO AMEND APPLICATION UNDER SECTION 67 (6) OR SECTION 108 (c).
SIR,—
I hereby request that .
[Signature.]
Dated this day of , 19 .
To the Registrar, Patent Office, Wellington, New Zealand.

[Form No. 21.
Stamp, 5s.*
(Leave uncanceled.)
The Patents, Designs, and Trade-marks Act, 1911.
REQUEST TO ENTER CHANGE OF NAME OF REGISTERED PROPRIETOR OF TRADE-MARK UPON THE REGISTER.
I [or WE] [Here insert name, address, and description] hereby request that you will enter my [or our] name[s] in the Register of Trade-marks as proprietor[s] of the Trade-mark No. in Class .
I am [or We are] entitled to the said trade-mark and to the goodwill of the business concerned in the goods with respect to which the said trade-mark is registered.
There has been no change in the actual proprietorship of the said trade-mark, but [Here state the circumstances under which the change of name took place].
[Signature.]
Dated this day of , 19 .
To the Registrar, Patent Office, Wellington, New Zealand.

• If more than one mark, attach 5s. for first mark and 1s. for every other mark.

[Form No. 22.
Stamp, 5s.
(Leave uncanceled.)
The Patents, Designs, and Trade-marks Act, 1911.
FORM OF APPLICATION BY PROPRIETOR OF REGISTERED TRADE-MARK TO CANCEL ENTRY ON REGISTER.
Trade-mark No. , Class , advertised in page .
Name of registered proprietor: .
Place of business: .
Description: .
I, THE undersigned , of [or I, the undersigned, , a member of the firm of , of , on behalf of my said firm] apply that the entry upon the Register of Trade-marks of the Trade-mark No. in Class may be cancelled.
[Signature.]
Dated this day of , 19 .
To the Registrar, Patent Office, Wellington, New Zealand.

[Form No. 23.
Stamp, 5s.
(Leave uncanceled.)
The Patents, Designs, and Trade-marks Act, 1911.
REQUEST TO STRIKE OUT GOODS FROM THOSE FOR WHICH A TRADE-MARK IS REGISTERED.
I, , of , hereby request that you will strike out from the goods for which the Trade-mark No. is registered in Class .
[Signature.]
Dated this day of , 19 .
To the Registrar, Patent Office, Wellington, New Zealand.

[Form No. 24.
Stamp, 5s.
(Leave uncanceled.)
The Patents, Designs, and Trade-marks Act, 1911.
REQUEST TO ENTER DISCLAIMER OR MEMORANDUM RELATING TO A TRADE-MARK.
I, , of , hereby request that you will enter in the register in connection with Trade-mark No. in Class the following , namely,—
[Signature.]
Dated this day of , 19 .
To the Registrar, Patent Office, Wellington, New Zealand.

[Form No. 25.
Stamp, £1.*
(Leave uncanceled.)
The Patents, Designs, and Trade-marks Act, 1911.
APPLICATION UNDER SECTION 88 TO ADD TO OR ALTER A TRADE-MARK.
In the matter of the Trade-mark No. in Class .
APPLICATION is hereby made on behalf of the registered proprietor of the trade-mark numbered as above to alter it in