APRIL 30.] THE NEW ZEALAND GAZETTE. 1581

To the Superintendent (Advances to Local Authorities Branch), State 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 entertained by the State 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 per centum per annum.
   (c.) The term to be thirty-six years and a half, and loan to be repaid by instalments in accordance with the prescribed table.
   (d.) The loan-money is required on the day of , 19 [or in instalments of (State amounts of instalments of loan, not exceeding four, and dates of payment, not to extend beyond a year from date of granting of the loan)].
   (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 notification thereof was duly given in the [State newspaper] on the [State dates]. A copy of the special order, under seal, containing the dates of adoption and confirmation and duly certified to by the Chairman is hereto attached.

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.

5. The rateable value 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. 5.

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—
C. D.,
Justice of the Peace [or Solicitor].

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

Form No. 6.

DEBENTURE.

[Name of local authority], New Zealand.
[Name of loan] Loan.

Loan of [State amount] from the State Advances Office.
Issue of [State number] debentures of [Not less than £20 nor more than £1,000] each, numbered 1 to , bearing interest at [State rate] per centum per annum.

These debentures are issued under the provisions of the Local Bodies’ Loans Act, 1913.

Debenture No. .

1. THE [Full name of body corporate], being a body corporate under the [Name of Act], in consideration of the sum of [Not less than £20 nor more than £1,000] lent to the said body corporate by the State Advances Superintendent, does hereby bind itself to pay to the said Superintendent or to the bearer of this debenture the said sum of [State amount], together with interest thereon at the rate of [State rate] per centum per annum.

2. The said principal and interest shall be payable in accordance with the table of repayments endorsed hereon by equal half-yearly instalments of [State amount in accordance with endorsed table] during a period of thirty-six years and a half, the first of those instalments being payable on the [State date, six months after the date of the loan] day of , 19 .

3. The said instalments shall include both principal and interest in accordance with the endorsed table, and full payment thereof shall constitute a complete discharge of this debenture.

4. All sums payable under this debenture shall be paid at the office of the said Superintendent at Wellington.

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