172
THE NEW ZEALAND GAZETTE.
[No. 3

21. RETURN OF DEBENTURES ISSUED DURING THE YEAR
    ENDED 31ST MARCH, 19 .
    The Land and Income Assessment Act, 1908, and its amendments.

Name of local authority making return: .

| Name of
Debenture-holder. | Address. | Amount.
issued. | Rate of
Interest. | Remarks. |
|--- | --- | --- | --- | --- |
| | | £ | | |

I, the person making the foregoing return, do solemnly and
sincerely declare that it is true and accurate in every par-
ticular. And I make this declaration under the provisions of
the Land and Income Assessment Act, 1908, and its amend-
ments.

[Usual signature and description.]

22. RETURN OF INTEREST PAID OR PAYABLE TO DEPOSITORS
    DURING THE YEAR ENDED 31ST MARCH, 19 .
    The Land and Income Assessment Act, 1908, and its amendments.

Name of person, firm, company, or local authority making
return: .

| Name
of Depositor. | Address. | Interest paid
or payable. | Remarks. |
|--- | --- | --- | --- |
| | | £ | |

I, the person making the foregoing return, do solemnly and
sincerely declare that it is true and accurate in every par-
ticular. And I make this declaration under the provisions of
the Land and Income Assessment Act, 1908, and its amend-
ments.

[Usual signature and description.]

23. NOTICE OF ASSESSMENT OF LAND-TAX.
    The Land and Income Assessment Act, 1908, and its amendments.

Land and Income Tax Department,
Wellington, , 19 .

To
Notice is hereby given that you are liable to land-tax in
respect of land and mortgages owned as at 31st March, 19 ,
as follows:—

, Commissioner of Taxes.

Land-tax. Mortgage-tax.
£ £

Unimproved value of land (par-
ticulars hereunder) .. ..
Value of mortgages owing to you ..

Deductions—Mortgages owing by
you .. ..

Balance .. ..
Exemption.. ..

Taxable amount ..

Tax .. .. |@| £ s. d. |@| £ s. d. |

Graduated Land-tax.
£

Unimproved value of land (particulars hereunder) ..
Taxable amount .. .. .. ..
Graduated tax .. .. .. ..

Total tax payable .. .. ..£

24. NOTICE OF ASSESSMENT OF LAND-TAX.
    The Land and Income Assessment Act, 1908, and its amendments.

Land and Income Tax Department,
Wellington, , 19

To
Notice is hereby given that you are liable to land-tax in
respect of land and mortgages as follows:—

Land-tax. £ £

Unimproved value of land as assessed last
year .. .. .. ..
Add increases during year, as below ..

Less decreases.. .. ..

Value of mortgages owing to you ..
Deductions—Mortgages owing by you ..
Balance .. .. ..
Exemption .. .. ..

Taxable amount .. £

Graduated Land-tax.

Unimproved value of land .. ..

Taxable amount .. .. £

Increases.

Decreases.

, Commissioner of Taxes.

25. NOTICE OF ASSESSMENT OF INCOME.
    The Land and Income Assessment Act, 1908, and its amendments.

Land and Income Tax Department,
Wellington, , 19 .

Take notice that your name appears on the income-tax
assessment roll in respect of income derived or received
during the year ending on 31st day of March, 19 , as below.

If you consider yourself aggrieved by this assessment you
may make objection in the prescribed manner.

Objections must be signed by the objector, and should be
written on the prescribed form (which may be obtained at
any post-office) and posted to me not later than the of
, 19 .

, Commissioner of Taxes.

To
£ £

Income from business .. .. ..
Less deductions .. .. ..

Income from employment or emolument ..
Less deductions .. .. ..

Less 5 per cent. on the capital value of the
taxpayer’s interest in business premises..
Life-insurance premium .. ..
Exemption .. .. ..

Taxable amount .. .. .. £

Tax payable: £