2248

THE NEW ZEALAND GAZETTE.
[No. 80

SECOND SCHEDULE.
(Reg. 3.)

FORM OF CLAIM FOR ENROLMENT.
Under the Municipal Corporations Act, 1920.

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

I, [ ], [State full name, occupation, and place of residence], hereby claimed to be enrolled.
on the district electors list of [' Ward of] the Borough of , on the grounds herein-
after 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 freehold qualification.]
(2.) I claim to be enrolled by virtue of a freehold qualification, being the beneficial and duly
registered owner of a freehold estate in the following land within [the Ward of] the borough
the capital value whereof is not less than £25:—
Building, if any ; Section, ; Block, ; Street, ; number
on valuation list, if known.

[In the case of a rating qualification.]
(2.) I claim to be enrolled by virtue of a rating qualification 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 by virtue of a residential qualification 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].

[In the case of an occupier's qualification.]
(2.) I claim to be enrolled by virtue of an occupier's qualification 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. [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 Post-
master, or minister of religion, or elector of the Borough of , or Town Clerk].

Note.—By section 6 of the Municipal Corporations Act, 1920, 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. 7, 11, 12.)

FORM OF OBJECTION TO DISTRICT ELECTORS LIST OR ROLL.
Under the Municipal Corporations Act, 1920.

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 9
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 9 to be printed on back.]

FOURTH SCHEDULE.
(Reg. 8.)

LIST OF OBJECTIONS TO THE DISTRICT ELECTORS LIST.
Under the Municipal Corporations Act, 1920.

A. B., Town Clerk.

J. W. BLACK,
Acting Clerk of the Executive Council.