$2062
THE NEW ZEALAND GAZETTE.
[No. 86

FORM No. 14.

STATUTORY DECLARATION IN SUPPORT OF APPLICATION FOR
EXEMPTION FROM SECTION 68.

The Land and Income Tax Act, 1916.

I,
, of
do solemnly and sincerely declare—

1. That on the
   day of
   , 19
   , I agreed to
   sell, and
   , of
   agreed to purchase, the land
   described in the Schedule hereto.
2. That the said agreement has been duly executed and is
   still in force.
3. That possession of the said land has been delivered by
   me to the said purchaser in pursuance of the said agreement,
   and that he is still in possession of the same.
4. That the total purchase-money under the said agreement
   is £
   and that the sum of £
   being part
   thereof, has been paid to me by the said purchaser in pur-
   suance of the said agreement.
5. That no money has been lent by me, directly or indirectly,
   to the said purchaser and is still unpaid.
6. That no liability of the said purchaser is directly or
   indirectly guaranteed by me.
7. That no money other than the said purchase-money
   is owing to me on the security of the said land.
   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.

[Signature.]
Declared at
, this
day of
, 19
,
before me—
, a Justice of the Peace [or Solicitor, or
Notary Public).

THE SCHEDULE ABOVE REFERRED TO.

All that parcel of land, containing by admeasurement
, and being

FORM NO. 15.

INFORMATION TO BE FURNISHED TO THE COMMISSIONER IN
SUPPORT OF APPLICATION FOR SPECIAL EXEMPTION UNDER
SECTION 50.

The Land and Income Tax Act, 1916.

Questions to be put to Applicant.
Answers.

1. What is your present age?
2. What was your total income from all sources
   during the year ended 31st March, 19 ? ..
3. Are you incapacitated, by reason of age, ill health,
   or other disability, from earning any further
   income? If so, state cause of incapacity
4. Are you in receipt of any monetary assistance
   from relatives or other persons? If so, state
   amounts
5. What are the relationships and the respective ages
   of the persons (if any) dependent on you for
   support?
6. If the premises occupied by you are also owned
   by you, what is their annual letting value?..
7. What is the amount of the exemption for which
   you apply under the said section 50?

I,
, of
, do hereby solemnly and sincerely
declare that the above-written answers made by me to the
above questions are true and correct in every particular.
Dated at
, this
day of
, 19
.
[Signature of applicant.]

FORM No. 16.

BOND.

The Land and Income Tax Act, 1916.

Know all men by these presents that I
, of
(taxpayer), trading under the style and title of
, and
, of
, and*
, of
(sureties), are held and firmly bound unto our Sovereign
Lord King George the Fifth in the sum of
sterling,
to be paid to our said Lord the King, his heirs and succes-
sors; to which payment well and truly to be made we bind
ourselves and every of us, jointly and severally, for and
in the whole, our and every of our heirs, executors, and
administrators, firmly by these presents. Sealed with our
seals. Dated thist
day of
, one thousand
nine hundred and

WHEREAS by the Land and Income Tax Act, 1916, it is pro-
vided that the Commissioner of Taxes may at any time and
from time to time require any non-resident trader or non-
resident agent to give security by way of bond, deposit, or
otherwise to the satisfaction of the Commissioner for the
payment of any income-tax which may become payable by
him; and whereas it appears that the said
hath pro-
posed to give the security of these presents for the due payment
of all income-tax which may become payable by him, and the
said Commissioner has agreed to accept such security: Now,
the condition of the above-written bond or obligation is such
that if the said
shall, upon demand, make to the said
Commissioner such returns or statements as he (the said
Commissioner) may from time to time require, and shall also
pay to the said Commissioner all income-tax which under
the provisions of the said-recited Act or the regulations there-
under may be lawfully assessed or levied upon him, then the
above-written bond or obligation shall be void, but otherwise
shall be and remain in full force and virtue.

[L.S.]
[L.S.]
[L.S.]

Signed, sealed, and delivered by the above-named
in the presence of

• Names, residences, and occupations, in words at length, of taxpayer
  and of two sureties.
  † Date of first signature in words at length.

FORM No. 17.

RECEIPT FOR DEPOSIT.

The Land and Income Tax Act, 1916.

£

RECEIVED from
, of
, the sum of £
by way of deposit made pursuant to section 106 of the Land
and Income Tax Act, 1916, as security for the due payment
of income-tax on the profits derived from the business
of

Such deposit to be returnable at the discretion of the
Commissioner of Taxes.

Commissioner of Taxes, Wellington.
Dated this
day of
, 19
.
Countersigned by
, Collector of Customs, [or Receiver
of Land and Income Tax].

FORM No. 18.

WARRANT TO NON-RESIDENT AGENT UNDER SECTION 105.

The Land and Income Tax Act, 1916.

To [Name and address].

I,
, the Commissioner of Taxes within the Dominion
of New Zealand [or Collector of Customs at
as the
case may be], in pursuance of the power conferred on me
by section 105 of the Land and Income Tax Act, 1916, do
hereby authorize you to act in New Zealand as a non-resident
agent for or on behalf of [Names, addresses, and occupations
of principals].

This warrant shall continue in force during your present
visit to New Zealand only, but may be revoked at any time
before that date. You are respectfully requested to forward
this warrant to the Commissioner of Taxes at Wellington prior
to your departure from New Zealand.
Given under my hand at
, this
day of
, 19
.

Commissioner of Taxes [or Collector of Customs].

FORM NO. 19.

WARRANT TO NON-RESIDENT TRADER TO CARRY ON BUSINESS
IN NEW ZEALAND UNDER SECTION 105.

The Land and Income Tax Act, 1916.

I, To [Name, address, and occupation].

, the Commissioner of Taxes within the Dominion
of New Zealand [or Collector of Customs at
as the
case may be], in pursuance of the power conferred on me by
section 105 of the Land and Income Tax Act, 1916, do hereby
authorize you to carry on business in New Zealand as a non-
resident trader. This warrant shall continue in force until
the
day of
, 19
, but may be revoked at
any time before that date.
Given under my hand at
, this
day of
, 19
.

Commissioner of Taxes [or Collector of Customs].

J. F. ANDREWS,
Clerk of the Executive Council.