Nov. 11.] THE NEW ZEALAND GAZETTE. 3203

Form 25 (Regs. 33 and 65).
Under the Mining Act, 1926.

APPLICATION FOR CERTIFICATE OF PROTECTION.

To the Warden of the Mining District, at .
Pursuant to the Mining Act, 1926, the undersigned [Full name, residence, and occupation] hereby applies for a protection certificate for the period of in respect of the mining privilege[s] specified in the Schedule hereto.

Address for service :
Dated at , this day of , 19 .

SCHEDULE.

[Signature of applicant, &c.]

Precise time of filing application, &c.
Time and place, &c.

Form 26 (Regs. 33 and 67).
Under the Mining Act, 1926.

APPLICATION FOR CERTIFICATE OF EASEMENT.

To the Warden of the Mining District, at .
Pursuant to the Mining Act, 1926, the undersigned [Full name, residence, and occupation], being the holder of the following mining privilege—[Specify its name, locality, and registered number]—hereby applies for a certificate of easement in respect of the land specified in the First Schedule hereto, which has been duly marked out for the purpose, and is portion of the mining privilege specified in that Schedule.

The works to be constructed and the rights to be exercisable under the certificate of easement are as specified in the Second Schedule hereto.

Address for service :
Dated at , this day of , 19 .

FIRST SCHEDULE.

[Specify the land with reasonable particularity, as also the name, locality, registered number (if any), and holder of the mining privilege in which such land is comprised.]

SECOND SCHEDULE.

[Specify with reasonable particularity the works to be constructed and the rights to be exercised under the certificate.]

[Signature of applicant, &c.]

Precise time of filing application, &c.
Time and place, &c.

Form 27 (Reg. 33).
Under the Mining Act, 1926.

OBJECTION TO AN APPLICATION.

In the matter of an application numbered in the Application Record-book, at , for [Here state nature of application to which objection is made].

THE undersigned [Full name, residence, and occupation] hereby gives notice that he objects to the granting of the above-described application, and the following are the grounds of his objection, namely,—
[Here set out grounds of objection clearly, concisely, and in consecutive paragraphs.]

Address for service :
Dated at , this day of , 19 .

[Signature of objector, &c.]

Form 28 (Reg. 33).
Under the Mining Act, 1926.

DECLARATION WHERE APPLICANT DOES NOT DESIRE TO APPEAR.

In the matter of an application numbered in the Application Record-book at , for [State subject-matter of application].

I, A. B. [Full name, residence, and occupation], do hereby solemnly and sincerely declare as follows :—

1. That I am the applicant [or one of the applicants] named in the above-described application.
2. That all the statements contained in the application are true.
3. That all prescribed provisions as to marking out the ground referred to in the application, posting notices thereon, serving notices on all persons affected, and otherwise, have been duly observed, in so far as is required by law.
4. That the ground applied for does not cross any road or street, and is Crown land open for mining within the meaning of the Mining Act, 1926.
5. That I believe myself [or the applicants] to be entitled to the grant of the application, and know of no valid objection thereto.
6. That, so far as I am [or the applicants are] aware, no public or private rights will be prejudicially affected by the grant of the application.
7. [Here set out such other facts as may be necessary.]
   And I make this solemn declaration conscientiously believing the same to be true, and by virtue of the Justices of the Peace Act, 1908.

A. B.

Declared at , this day of , 19 .
before me— , a Justice of the Peace for the Dominion of New Zealand [or as the case may be].

Form 29 (Reg. 33).
Under the Mining Act, 1926.

LICENSE FOR A CLAIM OTHER THAN AN ORDINARY CLAIM.

Pursuant to the Mining Act, 1926, I, the undersigned, , a Warden of the Mining District, do hereby grant to [Full name, residence, and occupation] this license for [Set out class and subdivision of claim—e.g., a special dredging claim, an extended quartz claim, or otherwise, as the case may be, not being an ordinary claim], in respect of the land described in the First Schedule hereto.

This license is granted for a term of years, commencing on the date hereof, subject to the payment of the rent as specified in the Second Schedule hereto, and also to the terms, conditions, reservations, and provisions set out in the aforesaid Act and the regulations thereunder, and to such additional terms, conditions, reservations, and provisions as are specified in the Third Schedule hereto.

In witness whereof I have hereunto subscribed my name, and affixed the seal of the Warden’s Court at , this day of , 19 .

FIRST SCHEDULE.

All that area of land in the Mining District, containing by admeasurement acres roods and perches, more or less, situate [Here set out section, block, survey district, boundaries, and measurements; and, if land is surveyed, affix plan].

SECOND SCHEDULE.

1. A rental in respect of each acre or portion thereof at the rate of 2s. 6d. a year for the period elapsing between the date hereof and the last day of June [or December] ensuing after the expiration of one year from the date hereof, 5s. for the next succeeding year, and 7s. 6d. for each subsequent year during the term of the license: the amount of the rental being—for the first year, £ ; for the next succeeding year, £ ; and for each subsequent year, £ . In case of Native land, a rental in respect of each acre or portion thereof at the rate of 1s. per annum, the amount of the rental for each year being £ .
2. All payments in respect of the aforesaid rent have been duly made up to the last day of June [or December] next following the date of this license, and the subsequent payments are to be made by half-yearly instalments in advance, the first half-yearly instalment being due and payable in advance on the last day of June [or December] aforesaid.

THIRD SCHEDULE.

1. The right of the public to use all tracks over and across the land held under this license for so long and until proper roads are provided and open for public traffic is reserved.
2. The right to take all roads for public purposes which shall, in the opinion of the Warden, be necessary is reserved without any claim for compensation, except where such roads may interfere with workings actually in use; and the licensee shall also take out and hold in his own name a miner’s right relating to Native ceded land in respect of every person employed in mining on such area, whether on wages, or as a tributer, or as a contractor.
3. That the owner hereof will bona fide and continuously work the claim by carrying on mining operations for gold hereon with reasonable diligence and skill, and will commence such operations within from the date of this license.
   [Set out additional terms, &c., if any.]

, Warden,