New Zealand Gazette – 1926 – No. 27

Page 1201

✨ Death Duties Forms



MAY 6.] THE NEW ZEALAND GAZETTE. 1201

Declaration.

I [donor, beneficiary, or trustee of beneficiary], do solemnly and sincerely declare :—

  1. That the statement hereunder written and marked " A " contains true and full particulars of all property, both real and personal, comprised in the gift of the above-mentioned date made by the above-named donor to the above-named beneficiary.
  2. That the value of the property set forth in such particulars is to the best of my knowledge and belief the true and full value of the said property as at the time of the making of the gift of such property.
  3. That to the best of my knowledge and belief the said beneficiary is not entitled as against the donor or any other person, or as against any other property, to any available right of indemnity or contribution in respect of the encumbrances affecting the said property as set out in such statement.
  4. That, with the exception of gifts made in good faith as part of the normal expenditure of the above-named donor, and not exceeding £20 in the aggregate in favour of any one beneficiary in the course of one calendar year, no other gift, whether to the same or any other beneficiary, has been made by the above-named donor at the same time or within the space of twelve months before or after the date of the gift above referred to, other than the gifts of which particulars are set out in the statement hereunder written and marked " B," and that the particulars set out in that statement are true.
  5. That the document attached hereto and marked " C " is [a true copy of] the instrument creating or evidencing the said gift made on the date first above mentioned.
    And I make this solemn declaration conscientiously believing the same to be true, and by virtue of the Justices of the Peace Act, 1908.

Declared at , by the said ,
this day of , one thousand
nine hundred and , before me—

............................................................
A Solicitor of the Supreme Court of New Zealand.
[or A Justice of the Peace for the Dominion of New Zealand.]

A.

Particulars and Value of Property comprised in the Gift hereinbefore referred to.

(NOTE.—Schedule Nos. 1 to 26, as may be applicable, may be annexed hereto for the purpose of supplying full particulars.)

Date of Gift. Particulars of Property. Consideration (if any). No. of Schedule (if any). Value irrespective of Consideration.
Total amount of consideration .. £ Total value .. £

Particulars of Encumbrances existing upon the Property comprised in the Gift hereinbefore referred to as to which there is no Right of Indemnity against the Donor or any other Person or Estate.

Date of Encumbrance. Name of Person holding Encumbrance. Nature of Encumbrance and Property charged therewith. Amount secured.
£ s. d.
£

B.

Particulars of other Gifts made at the same Time or within Twelve Months before or after the Date of the above-mentioned Gift.

Assessment of Gift Duty.

Total value of gifts .. .. .. .. .. .. .. .. £ __

Less amount of encumbrances .. .. .. .. .. .. .. £ __

Less amount of any consideration paid by beneficiary .. .. .. .. £ __

____ £ __

Amount dutiable .. .. .. .. .. .. .. .. .. £ __

Duty on £ , at £ per cent. .. .. .. .. .. .. £ __

Death Duties Act, 1921, Part IV.

Receipt No. issued for £

............................................................
Assistant Commissioner of Stamp Duties.



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💰 Forms and Statements under Death Duties Act (continued from previous page)

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