APRIL 10.] THE NEW ZEALAND GAZETTE. 1265

Form No. 5.

Application for a Loan under the New Zealand State-guaranteed Advances Act, 1909.

(Where loan to be raised by special order only.)

Application of [Name of local authority].
Amount of loan applied for: £
Term of loan: Thirty-six years and a half, on the instalment system.
Purpose for which loan required: .
Special-rating district or area: .
Date of application: .

To the Superintendent (Advances to Local Authorities Branch), New Zealand State-guaranteed Advances Office, Wellington.

1. THE above-named local authority hereby applies for a loan of £ , in respect of which a preliminary application was made on the day of , 19 , and provisionally approved by the New Zealand State-guaranteed Advances Board, as notified by you on the day of , 19 .

2. The terms and conditions on which this loan is applied for are,--
   (a.) The loan is for the purpose of [State purpose], which is to cost £ .
   (b.) The rate of interest to be one-eighth per centum per annum more than the rate at which the money was raised.
   (c.) The term to be thirty-six years and a half, and loan to be repaid by instalments in accordance with the appropriate table.
   (d.) The loan-money is required on the day of , 19 [or in instalments of (State amounts and dates of instalments of loan, not exceeding five)].
   (e.) The security for repayment of the loan is,--
   (i.) A special rate of in the pound over [Describe special-rating district or area].
   (ii.) [State any other security.]

3. The special order authorizing the raising of the loan was duly made or adopted on the day of , 19 , and confirmed on the day of , 19 ; and public notifications thereof were duly given in the newspaper of the , 19 . A copy of the special order, under seal, is hereto attached, marked “A.”

4. The resolution making a special rate of in the pound on all rateable property in the said special-rating district was duly passed on the day of , 19 ; and public notification thereof was duly given in the New Zealand Gazette of the , 19 (page ). A copy of the resolution, under seal, is hereto attached, marked “B.”

5. The rateable valuation of all rateable property in the special-rating district is £ , and the special rate of in the pound thereon will yield an annual sum of £ , which is sufficient to meet 10 per centum more than the periodical payments in respect of the loan as they fall due.

6. All statutory and other proceedings have been duly taken and all conditions have been duly fulfilled which are necessary for the raising of the said loan and for the making of the said special rate as a security therefor.

7. A copy of each of the newspapers referred to in this application is forwarded herewith.

A. B.,
Mayor [or Chairman, or Clerk].

Form No. 6.

Declaration verifying Application for Loan.

I, A. B., Mayor [or Chairman, or Clerk] of [Name of local authority], do solemnly and sincerely declare that the statements contained in the foregoing application are true and correct in every particular.

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 , this
day of , 19 , before
me—

, Justice of the Peace
[or Solicitor of the Supreme Court].

A. B.

J. F. ANDREWS,
Clerk of the Executive Council.