Aug. 12.] THE NEW ZEALAND GAZETTE. 2471

61

No. 19.—ACTION BY MEDICAL PRACTITIONER.

THE plaintiff claims £ for attendance and visits as a medical practitioner upon and
medicines supplied to [the family of] the defendant, between the day of , 191 ,
and the day of , 19 , as under [or detailed particulars of which are hereto
attached.

No. 20.—WORK DONE BY A COMMISSION AGENT.

THE plaintiff claims £ for the work, journeys, and attendance of the plaintiff, performed
for the defendant at his request, as a commission agent in the sale of a certain farm the pro-
perty of the defendant, namely: A commission at the rate of per centum on £ ,
as previously agreed between the plaintiff and the defendant [or as the case may be].

No. 21.—CLAIM BY A WAREHOUSEMAN.

THE plaintiff claims £ for work done by the plaintiff in keeping and taking care of goods
for the defendant at his request, and for warehouse room for the said goods by the plaintiff
found and provided for the defendant at his request, between the day of , 19 ,
and the day of , 19 .

No. 22.—CLAIM BY CARRIER FOR CARRIAGE OF GOODS.

THE plaintiff claims £ for the conveyance of goods by the plaintiff for the defendant at
his request [or at the request of A. B., the agent of the defendant], as follows: [Insert the items,
with dates and amounts].

No. 23.—CLAIM FOR FREIGHT.

THE plaintiff claims £ for freight for the conveyance of goods in a certain steamship
called the ["British Queen"] by the plaintiff for the defendant at his request [or at the request
of A. B., the agent of the defendant], as follows: [Insert the items, with dates and amounts].

No. 24.—CLAIM FOR WAGES.

THE plaintiff claims £ for wages as the hired servant of the defendant from the
day of , 191 , to the day of , 19 , at the rate of shillings a day
[or week].

No. 25.—CLAIM FOR WORK DONE BY CONTRACT.

THE plaintiff claims £ for materials furnished and work and labour done by the plaintiff
for the defendant at his request, in [State work done] under a written agreement entered into
by the plaintiff with the defendant on the day of , 19 , as follows: [Insert
items, with dates and amounts].

No. 26.—CLAIM FOR WRONGFUL DISMISSAL.

THE plaintiff claims £ for that, the plaintiff being the hired servant of the defendant at
the wages of £ per year, payable monthly, the defendant wrongfully dismissed the plain-
tiff on the day of , 19 , during the current year of his service.

No. 27.—CLAIM FOR MONEY LENT.

THE plaintiff claims £ , the amount of money lent by the plaintiff to the defendant on
the day of , 19 , and which has not been repaid [or, if lent at several times, say
"as follows," and insert dates and amounts].

No. 28.—CLAIM FOR MONEY PAID.

THE plaintiff claims £ , the amount of money paid by the plaintiff to A. B. for the de-
fendant at his request on the day of , 19 [or, if paid at several times or to dif-
ferent persons, say "as follows," and insert dates, names, and amounts].

No. 29.—ACTION FOR CONTRIBUTION (SECTION 54 OF ACT).

THE plaintiff claims £ as the amount of contribution due in law from the defendant to
the plaintiff by reason of the plaintiff having been sued in the Magistrate's Court at by
A. B. for the sum of £ , recoverable against the plaintiff and the defendant jointly, and
judgment recovered against the plaintiff, and paid and satisfied by him on the day of
, 19 . The plaintiff claims the same sum as money paid by him to defendant's use.
The statement of claim plaintiff was sued on is as underwritten [or hereto attached].