Nov. 18.] THE NEW ZEALAND GAZETTE. 3871

SECOND SCHEDULE. (Reg. 3.)

FORM OF CLAIM FOR ENROLMENT.

Under the Municipal Corporations Acts.

Claim for Enrolment on the District Electors List [of Ward] of the Borough of .

To the Town Clerk.

I, THE undersigned [State full name, occupation, and place of residence], hereby claim to be enrolled on the district electors list of [ Ward of] the Borough of , on the grounds hereinafter set forth.

(1.) The qualification is possessed by me in my own right [or, as the case may be, the right of my husband (or wife), whose full name is (Set out full name of husband or wife)].

[In the case of a freeholder’s qualification.]

(2.) I claim to be enrolled on the freehold list as beneficial and duly registered owner of a freehold estate in the following land within [the Ward of] the borough [Set out description of land by reference to section and block], the capital value whereof is not less than £ .

[In the case of a ratepayer’s qualification.]

(2.) I claim to be enrolled on the ratepayers list as a ratepayer in respect of the following property within [the Ward of] the borough :—

Building, if any, ; Section, ; Block, ; Street, ; number on valuation list, if known, ; term of lease, if any, .

[In the case of a residential qualification.]

(2.) I claim to be enrolled on the residential list as having resided for one year in New Zealand, and in [the Ward of] the borough during the three months now last past, and as being a British subject by birth [or by naturalization in New Zealand].

[Or]

(2.) I claim to be enrolled on the residential list as being, and for not less than three months now last past having been, in occupation, as undermentioned, of a building within [the Ward of] the borough as tenant at a rental at the rate of not less than £10 per year for each residential occupant under the tenancy. [Set out the description and situation of the building, or, if more than one, then of each building occupied during any portion of the three months, specifying in each case the name of the landlord, the term of the tenancy, the rental payable thereunder, the period of actual occupation, and, if the number of occupants under the tenancy exceeds one, the number of them and the name of each of them.]

Declaration to be signed by every claimant.

I hereby solemnly and sincerely declare that the foregoing statements are true, and that I verily believe myself to be entitled to be enrolled in terms of this my claim.

Dated at , this day of , 19 .

…………………………
Claimant.

Signed by the said , the claimant, in the presence of me— , J.P. [or Postmaster, or minister of religion, or elector of the Borough of , or Town Clerk].

NOTE.—By section 3 of the Municipal Corporations Amendment Act, 1913, every person who wilfully makes a false claim to have his name entered on the district electors list is liable to a fine not exceeding £5.

THIRD SCHEDULE. (Regs. 8, 13.)

FORM OF OBJECTION TO DISTRICT ELECTORS LIST OR ROLL.

Under the Municipal Corporations Acts.

I, [Full name, occupation, and place of residence], hereby object to the district electors list [or roll] of [the Ward of] the Borough of [Name of borough], on the grounds [State the person to whom the objection relates, and also such specific grounds of the objection, as set forth in section 10 of the Act, as are applicable.]

Given under my hand, this day of , 19 .

C. D.

Received by me this day of , 19 .

A. B.,
Town Clerk.

[Note.—Section 10 to be printed on back.]