1582
THE NEW ZEALAND GAZETTE.
[No. 43

5. The said body corporate hereby charges, as security for the payment of all moneys payable under this debenture and the other debentures of the same series, a special rate of [Insert sufficient description of special rate].

6. By way of further security for the said moneys the said body corporate hereby charges [Insert sufficient description of any other security given for the loan].

7. The holder of this debenture has no claim in respect thereof upon the Government or public revenues of New Zealand.

Issued under the common seal of the [Full name of body corporate], the day of , 19 .

A. B.,
Mayor [or Chairman].

C. D.,
Treasurer [or other officer appointed to countersign debentures].

[Endorse Table of First Schedule.]

Form No. 7.

DECLARATION VERIFYING DUE EXECUTION OF DEBENTURES.

I, A. B., Mayor [or Chairman] of [Name of local authority], do solemnly and sincerely declare—:

1. That a resolution, a copy of which is hereto attached, was passed at a meeting of [Name of local authority] duly called and constituted, held on , the day of , 19 , authorizing the common seal of [Full name of body corporate] to be affixed to the debentures numbered 1 to , issued in respect of the loan of £ from the State Advances Office.

2. That the said common seal was duly affixed to the said debentures in accordance with the said resolution.

3. That C. D., whose signature appears on the said debentures, is the Treasurer [or other officer] of [Name of local authority], and has been appointed by the said local authority to countersign those debentures.

4. That the signature “A. B.” on the said debentures is the proper handwriting of me, this deponent.

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—

E. F.,
Justice of the Peace [or Solicitor].

A. B.,
Mayor [or Chairman].

Form No. 8.

PRELIMINARY APPLICATION FOR A STATE GUARANTEE.

Name of local authority :
Address :
Date of application :

To the Superintendent (Advances to Local Authorities Branch), State Advances Office, Wellington.

THE above-named local authority hereby makes application for a State guarantee under Part IV of the Local Bodies’ Loans Act, 1913, in respect of a special loan of £ .

The purpose for which the loan is required is .

The area over which the special rate is to be levied is .

The annual rateable value of all rateable property in the said area is £ .

The system of rating in the said area is on the [State whether annual, capital, or unimproved value].

The loan is to be raised by [State whether by poll, special order, or written consent of ratepayers].

The total amount already owing on the security of rates over the rateable property in the said area is £ .

The amount collected annually on those rates is £ .

The security offered for the proposed loan is [State particulars of special rate and of any other security offered for the loan].

The rate of interest at which the loan is to be raised [See section 81 (b) and (c)].

The currency of the loan [See section 81 (b) and (c)].

If the loan is a joint special loan, state the name of the uniting local authority; also state the allocations of the aggregate amount of the loan.

A. B.,
Mayor [or Chairman].