Dec. 4.]

THE NEW ZEALAND GAZETTE.

CAUTION.—The applicant must himself sign the application. Any person signing for another, whether requested to do so or not, is liable to a fine of f50. The witness must not sign without having actually seen the applicant write his name or without actually hearing the person signing declare that he has read the statements and that the signature is in his own handwriting. Any person making a false declaration is liable to a fine of f20, or to three months' imprisonment.

[See back hereof.

[Back.]

Particulars to be filled in by Applicant.

Surname : Christian name : Occupation : Name of ship engaged on : Settled residence :

Signature of Applicant:

The Particulars within this Space are to be filled in by the Registrar.

(a.) Received (Date) :

(b.) Indexed (Date) : .
(c.) Checked (Date):

(d.) Approved (Date) : .
(e.) Transfer notice sent (Date) : .
(f.) Acknowledged (Date) :

NOTICE OF TRANSFER.

No. on Roll:

PLEASE remove from your Electoral Roll the name of—

Name in full [Surname, Christian Name].
Occupation on former roll:
Address on former roll:

as he was enrolled in this district on this day of , 192 .

...... , Registrar for the Electoral District of

[Form No. (3).

[Form No. (4).

NOTIFICATION OF DEATH TO BE GIVEN BY REGISTRAR OF DEATHS.

Surname of deceased:
Christian name:
Usual residence:
Occupation [In the case of female insert "Spinster," "Married," or "Widow"].
Age:
Date and place of death:

The above particulars are supplied in terms of section 7 of the Legislature Amendment Act, 1924.

....... , Registrar of Deaths at

[Form No. (5).

NOTIFICATION BY REGISTRAR OF MARRIAGES OF INTENDED MARRIAGE OF ADULT WOMAN.

NAME of bride : [Surname, Christian name].
Name of bridegroom : [Surname, Christian name].
Date of giving notice of marriage:
Full residential address (after marriage):
Particulars as to present registration of bride—
(a.) Name of Electoral District:
(b.) Full name and description as given on roll :
(c.) Address on roll:

The above particulars are supplied in terms of section 8 of the Legislature Amendment Act, 1924.

....... , Registrar of Marriages at

[Form No. (6).

APPLICATION FOR BALLOT-PAPER BY PERSON VOTING AS AN ABSENT VOTER.

I HEREBY make application to vote as an Absent Voter under section 13 of the Legislature Amendment Act, 1924, and the regulations made thereunder, and I declare that I am the person registered on the electoral roll for the Electoral District as—

[Surname, full Christian name].
[Full residential address, as appearing on roll].
[Occupation].

I also further declare that—

(a.) I am entitled to vote for the electoral district for which I am registered.
(b.) I am not qualified to be enrolled as an elector of any other electoral district.

Signed and declared before me this day of , 19 .

............., Deputy Returning Officer.
[or Postmaster].*
Booth No. ............Polling Place.
................Electoral District.

• Declaration may be signed before Postmaster only in case of a by-election.

Consecutive No. of voting-paper : .
Consecutive No. of declaration : .

[Form No. (7).

DECLARATION BY PERSON APPLYING TO VOTE WHOSE NAME HAS BEEN OMITTED FROM THE CERTIFIED COPY OF THE ROLL.

I, , do hereby declare as follows:—

(1.) That I made application for registration as an elector of the Electoral District, and was informed by the Registrar of Electors that my name had been entered on the electoral roll of the district.

B