1214
THE NEW ZEALAND GAZETTE.
[No. 27

3. That I am well acquainted with the value of scrip, stock, and shares in banks and companies, similar to those mentioned in the [Insert the number of schedule] Schedule hereto annexed, and that to the best of my knowledge and belief the sums of money set opposite the respective items of the property enumerated therein represent the full and true value of such property at the date of [Insert death of deceased, or gifts as set out in the said schedule, or vesting upon joint tenancy as set out in the said schedule, as the case may be].

4. That the total amount of that part of the dutiable estate of the deceased so represented in such schedule did not exceed in the aggregate the sum of pounds shillings and _ pence at the date mentioned.

5. That I am , and have carried on business at for a period of _ years.

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 , 19 , before
me—

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

———

Form No. 32.
Death Duties Act, 1921.

In the estate of _ (deceased).

DECLARATION TO BE ANNEXED TO THE TWENTY-FIFTH AND TWENTY-SIXTH SCHEDULES.

I, , of , do solemnly and sincerely declare—

1. That I am the administrator of the estate of the above deceased.

2. That to the best of my knowledge and belief the value of the real estate of the deceased situated out of New Zealand, as set out in the Twentieth-fifth Schedule annexed hereto, is £ , and no more, and that the said sum of £ represents the full saleable value of the said real estate in the country in which the said real estate is situated at the date of the death of the said deceased.

3. That to the best of my knowledge and belief the value of the personal estate of the deceased situated out of New Zealand, as set out in the Twenty-sixth Schedule hereto annexed, is £ , and no more, and that the said sum of £ represents the full saleable value of the said personal estate in the country within which the said personal estate is situated.

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 , 19 , before
me—

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

———

Form No. 33.
Death Duties Act, 1921.

NOTICE TO BE FILED WITH THE COMMISSIONER OF STAMP DUTIES WHERE PAYMENT IS MADE OUT OF THE ESTATE OF A DECEASED PERSON WITHOUT PROBATE OR LETTERS OF ADMINISTRATION HAVING BEEN OBTAINED.

(Section 61, Death Duties Act, 1921).

Name of deceased:
Occupation:
Address:
Date of death:

Name of person making payment:
Occupation:
Address:
Date of payment:

Name of person to whom payment is made:
Occupation:
Address:
Relationship to deceased:

Description of fund, account, or other source from which payment is made:
Amount of payment: £ _ .

I hereby certify that to the best of my knowledge and belief the above particulars are true.

[Signature of person making payment.]

F. D. THOMSON,
Clerk of the Executive Council.