768
THE NEW ZEALAND GAZETTE.
[No. 22

in the case of a company by the secretary or a director, and
in the case of a local authority by the Chairman or the Clerk.
26. The return of interest paid by banking and other
corporations, institutions, and persons required to be made
by section 158 of the said Act may be made in the form
No. 12 in the Schedule hereto.
27. (1.) The list required by section 8 of the Finance Act,
1921 (No. 2), may be made in the form No. 13 in the Schedule
hereto.
(2.) The notice to be given to the Commissioner pursuant
to section 8 of the Finance Act, 1921 (No. 2), that any person
has ceased to be the holder of a debenture, may be given in
the form No. 14 in the Schedule hereto.
28. The form of declaration and information required in
support of an application for refund of tax under section 37,
of the Finance Act, 1917, as amended by section 25 of the
Land and Income Tax Amendment Act, 1920, shall be in the
form No. 15 in the Schedule hereto.
29. The form of declaration to enable debenture-holders
whose home is in New Zealand and whose total income from
all sources does not exceed £300 to receive payment of the
interest without deduction for income-tax shall be in the
form No. 16 in the Schedule hereto.
30. The form of declaration to enable societies, trusts,
institutions, and other bodies coming within section 84 of
the said Act, to receive payment of interest on debentures
without deduction for income-tax shall be in the form No. 17
in the Schedule hereto.
31. The certificate of deduction of income-tax from pay-
ment of interest payable on debentures shall be in the form
No. 18 in the Schedule hereto.
32. The form of declaration that total income from all
sources does not exceed £2,000 shall be in the form No. 19
in the Schedule hereto.
33. The certificate of payment of income-tax shall be in
the form No. 20 in the Schedule hereto.
34. Every application to the Commissioner to exempt the
seller of any land from the operation of the provisions of
section 16 of the Finance Act, 1917, shall be supported by a
statutory declaration in the form No. 21 in the Schedule
hereto.
35. Every applicant for special exemption pursuant to
section 5 or 6 of the Finance Act, 1917, shall, in support of
such application, furnish to the Commissioner the informa-
tion indicated on the form No. 22 in the Schedule hereto,
and such further information as the Commissioner may
require.
36. (1.) The security that may be required of a non-
resident trader or non-resident agent, pursuant to section 106
of the said Act, may be by way of bond in the form No. 23
in the Schedule hereto.
(2.) Where the security required is by way of deposit the
Commissioner shall give a receipt therefor in the form No. 24
in the Schedule hereto.
37. Every warrant under section 105 of the said Act issued
to a non-resident agent and authorizing him to act as agent
shall be in the form No. 25 in the Schedule hereto; and
every warrant under the said section issued to a non-resident
trader and authorizing him to carry on business shall be in the
form No. 26 in the said Schedule.

APPLICATION OF REGULATIONS.

38. These regulations, so far as they relate to income-tax,
    shall not extend or apply to income derived during the year
    ending the 31st day of March, 1921; and, so far as they
    relate to land-tax, shall not extend or apply to all land owned
    at noon on the 31st day of March, 1921.

SCHEDULE.

FORM No. 1.

OATH OF FIDELITY AND SECRECY.

To be taken and subscribed by all persons appointed or
employed under the Land and Income Tax Act, 1916.
I, , of , do hereby swear that I will truly and
faithfully, according to the best of my knowledge and skill,
perform the duties imposed on or required of me under or for
the purposes of the Land and Income Tax Act, 1916, or under
or for the purposes of any other Act imposing taxes or duties
payable to the Crown, or relating to the imposition of taxa-
tion; and I do further swear that I will not, without lawful
authority, communicate to any person any matter or thing
coming to my knowledge in the performance of my duties,
except for the purpose of carrying into effect the Land and
Income Tax Act or other Act as aforesaid. So help me God!
[Signature.]
Sworn before me, at , this day of
19 .
Commissioner of Taxes [or Deputy Commis-
sioner of Taxes, or Justice of the Peace.]

FORM No. 2.

The Land and Income Tax Act, 1916, and Amendments.

RETURN OF LAND.

Owned or held under lease at noon on the 31st day of March,
19 , by

Postal address (where notices, &c., may be sent or served).

If owner is residing out of New Zealand, state date of departure from
New Zealand.

NOTE.—Before filling in this form please read the instruc-
tions on the back.

(a.) When land held jointly (whether in joint tenancy or
tenancy in common), state (here) the names and
addresses of all the joint owners and the interest which
each owner has in the land. If any owner is residing
out of New Zealand state also date of departure from
New Zealand:

(b.) If the land is held by a firm or partnership, state (here)
the name and address of each partner and his share in
the partnership property, and under “Surname”
(above) give the name of the firm or partnership. If
any partner is residing out of New Zealand state also
date of departure from New Zealand:

(c.) If the land is held by a company, state (here) the name and
address of the secretary or a director of the company,
and under “Surname” (above) give the name of the
company:

(d.) If the land is held by a deceased person’s estate or other
trust, state (here) the names and addresses of the
beneficiaries, and under “Surname” (above) give the
name of the estate or other trust. If any beneficiaries
are residing out of New Zealand state also date of
departure from New Zealand:

(e.) If the land is held by an association, club, council, society,
union, institution, or other body, state (here) the name
and address of secretary, and under “Surname”
(above) the name of the association, club, &c:

PART 1.

Amounts owing by the Taxpayer at noon on 31st March, 19 ,
secured on the land either by Registered Mortgage or by Agree-
ment to purchase.

NOTE.—Unregistered loans or unregistered overdrafts should
not be entered.

Registered No. of Mort-
gage. | Date of Registration,
or Date of Agree-
ment to purchase. | Rate of Interest. | No. of Lot, Section,
Block, Survey Dis-
trict, or other Refer-
ence to Land
charged. | Person to whom Money owing.
NOTE.—If not resident in New
Zealand state also name and address
of agent. | Amount of Principal
owing at Noon on
31st March, 19
£
--- | --- | --- | --- | --- | ---
Surname. | Christian
Name. | Address. |

PART 2.

Particulars as to other Charges on Land (e.g., Annuities or
Rent Charges) as at noon on 31st March, 19 .

No. of Lot, Section,
Block, Survey Dis-
trict, or other Refer-
ence to Land
charged. | Persons entitled. | Amount
payable
annually.
£
--- | --- | ---
Surname. | Christian
Name. | Address. | Occupa-
tion. | Age of Annuit-
ant or Term of
Rent Charge. |