Aug. 5.] THE NEW ZEALAND GAZETTE. 2759

Form 109 (Reg. 176).

GOLD-DEALER’S LICENSE.

I,
, Minister of Mines, being satisfied that
is a fit and proper person to be a licensed gold-dealer, do
hereby license the said
to be a gold-dealer under the
provisions of “The Mining Act, 1908,” and the regulations,
to carry on the business of a gold-dealer at
, in the
premises occupied by him and situate at
, within
the
Mining District, and at no other place, until the
31st day of December, 19
, and no longer.
Given under my hand, at Wellington, this
day
of
, 19
.
, Minister of Mines.

Entered in the Register of Licensed Gold-dealers.
, Registrar.

Form 110 (Reg. 177).

GOLD-DEALER’S LICENSE FOR INCORPORATED BANK.

I,
, Minister of Mines, by virtue of the powers con-
ferred upon me by section 371 of “The Mining Act, 1908,”
and the regulations, do hereby grant to
, an incor-
porated bank carrying on business at its head office at
,
a license to deal in gold at the branches described on the
back hereof, under the provisions of the said Act and regu-
lations, until the 31st day of December, 19
, and no longer.
Given under my hand, at Wellington, this
day of
, 19
.
, Minister of Mines.

Entered in the Register of Licensed Gold-dealers.
, Registrar.

List of Places where such Branches of the Bank are established,
and Names of Present Managers thereof.

Form 111 (Reg. 181).

GOLD-DEALER’S BOOK.

• Under this heading particulars must be stated as to whether the
  transaction was a sale, purchase, advance, or deposit for safe keeping.
  † Under this heading must be accurately set out the particulars of
  the gold dealt with, in accordance with the definition thereof contained
  in section 364 of “The Mining Act, 1908.”

Form 112 (Reg. 182).

RETURN OF GOLD BOUGHT OR SOLD BY AN INCORPORATED BANK OR LICENSED GOLD-DEALER FOR THE MONTH OF
, 19
.

(To be posted to the Under-Secretary of Mines not later
than the 5th day of each month.)

• Under this heading particulars must be stated as to whether the
  transaction was a sale, purchase, advance, or deposit for safe keeping.
  † Under this heading must be accurately set out the particulars of
  the gold dealt with, in accordance with the definition thereof contained
  in section 364 of “The Mining Act, 1908.”

I,
, manager of the
Bank at
[or a
licensed gold-dealer, whose registered address for business
is at
], do hereby certify that the foregoing is a true
and correct statement of all the transactions of my bank
[or of all my transactions] in gold during the month ending
, 19
.

Signature of licensee :

Address and description :

Date :

To the Under-Secretary of Mines, Wellington.

Form 113 (Reg. 183).

*DECLARATION AS TO GOLD SENT BY POST OR OTHERWISE**

I,
, of
, do solemnly and sincerely declare
as follows :—

1. I did on the
   day of
   , 19
   , forward to
   the
   Bank at
   by post, or by
   , a parcel
   containing [Here set out nature of contents and approximate
   quantity or weight thereof].

2. The said
   is my property [or the property of
   , of
   ], and was acquired by me [or him]
   [Here set out whether it was acquired by purchase or is the
   product of some mining lease, and in the former case the name
   and address of the seller, and in the latter case the name and
   situation of the lease and the holder thereof].

And I make this solemn declaration conscientiously believ-
ing the same to be true, and by virtue of “The Justices of
the Peace Act, 1908.”

Declared at
, this
day of
one
thousand nine hundred and
, before me—
Warden, Mining Registrar, Magistrate, Justice of the Peace,
Postmaster, or Constable.

• “Gold” includes gold, gold bullion, retorted gold, gold-ores, gold
  amalgam, gold-alloys, precipitates containing gold, slag, concentrates,
  tailings, and residues, but does not include coin or things manufactured
  of gold.

[To be forwarded to the Bank.]