Mar. 30.] THE NEW ZEALAND GAZETTE. 775

Earned. Unearned.
Gross income .. .. .. £ £
Add .. .. .. £ £
Deductions .. .. .. £ £
Less .. .. .. £ £
——— ———
£ £
Less depreciation of premises: £ at
per cent. .. .. .. £ £
Assessable income .. .. .. ——£ ——£
Add .. .. .. .. £
———£

Less special exemptions as under—
Under section 81, Land and Income Tax Act, 1916, as amended by section 27 of the Finance Act, 1917 .. .. £ £
Children allowance.. .. .. £ £
Life-insurance premiums, Superannuation and National Provident Fund contributions .. .. .. £ £
Contributions to support of widowed mother .. .. .. £ £
5 per cent. on unimproved value, £ , of the taxpayer’s interest in land used .. .. .. .. £ £
———£ ———£
Taxable income .. .. .. £ £
Total taxable income .. .. .. £

Tax payable on £ .. .. £
Plus 20 per cent. additional tax .. .. £
Less deduction in respect of earned income:
10 per cent. of of above tax .. £
———
Tax payable .. .. £

FORM No. 8.
NOTICE OF OBJECTION TO ASSESSMENT OF LAND-TAX.
The Land and Income Tax Act, 1916, and Amendments.
To the Commissioner of Taxes, Wellington.
I HEREBY give notice that I object to your assessment of land-tax in respect of land owned by me for the following reasons [Here state shortly and clearly the reasons for objection.]
[Date.] [Name.]
[Address.]

FORM No. 9.
NOTICE OF OBJECTION TO ASSESSMENT OF INCOME-TAX.
The Land and Income Tax Act, 1916, and Amendments.
To the Commissioner of Taxes, Wellington.
I HEREBY give notice that I object to your assessment of my income-tax on the following grounds [Here state shortly and clearly the reasons for objection].
[Name.]
[Date.] [Address.]

FORM No. 10.
NOTICE OF CHANGE OF OWNERSHIP OF LAND FOR LAND-TAX PURPOSES.
Memorandum for the Commissioner of Taxes, Wellington.
REFERRING to the undermentioned land, at present assessed in the name of [Surname, Christian name, occupation, address], I hereby give you notice, pursuant to section 23 of the Finance Act, 1917, that I have ceased to be the owner of the land, and that my successor in title is [Surname, Christian name, occupation, and address].
I also hereby declare that the particulars hereinafter set forth with respect to the said land are true and accurate:—

Date of sale or other disposition : .
Date on which purchaser entered into possession : .
Mode of disposition (e.g., sale, gift, or exchange, or as the case may be) : .
Amount of purchase-money .. .. .. £
Balance of purchase-money unpaid at noon on 31st March, 19 (if any): .. .. £
[Signature.]

C

FORM No. 11.
RETURN OF PERSONS EMPLOYED.
By [Name of employer] during any part of the Year ended the 31st March, 19 .

I, , of , do hereby solemnly and sincerely declare that the particulars set forth in the above return are true and correct in every particular.
Dated at , this day of , 19 .
[Signature of employer.]

FORM No. 12.
RETURN OF INTEREST PAID OR PAYABLE TO DEPOSITORS.
During the year ended 31st March, 19 .

I, , of , do solemnly and sincerely declare that the particulars set forth in the above return are true and correct in every particular.
Dated at , this day of , 19 .
[Signature.]

FORM No. 13.
LIST OF DEBENTURE-HOLDERS AT , 19 .
And other Particulars required in Terms of Section 8, Finance Act, 1921 (No. 2).

I, , of , do hereby solemnly and sincerely declare that this list includes particulars in respect of all the Debentures owing on the date indicated, and that all the particulars contained therein are true, accurate, and complete in every respect.
Dated at , this day of , 19 .
[Usual signature.]

FORM No. 14.
NOTICE OF CHANGE OF OWNERSHIP OF DEBENTURES FOR INCOME-TAX PURPOSES.
The Commissioner of Taxes, Wellington.
REFERRING to the undermentioned debenture, the interest on which is at present assessed in the name of [Surname, Christian name, occupation, and address], I hereby give you notice, pursuant to section 8 of the Finance Act, 1921 (No. 2), that I have ceased to be the owner of the debenture, and that the present holder is [Surname, Christian name, occupation, address].
I also hereby declare that the particulars hereinafter set forth with respect to the said debenture are true and accurate.

[Signature.]

NOTE.—Section 8 of the Finance Act, 1921 (No. 2), provides that neglect to notify the Commissioner of change of ownership of debenture renders the former owner liable to be assessed with the interest.