Nov. 11.

THE NEW ZEALAND GAZETTE.

3217

Form 106 (Reg. 171).

DECLARATION AS TO GOLD* SENT BY POST OR OTHERWISE.
I, ___, of ____, do solemnly and sincerely declare as follows:

1. I did on the ____ day of __, 19, forward to the Bank at by post, or by ___, a parcel containing [Here set out nature of contents and approximate quantity or weight thereof].

2. The said ____ is my property [or the property of __, of __], and was acquired by me [or him] [Here set out whether it was acquired by purchase or is the product of some mining lease, and in the former case the name and address of the seller, and in the latter case the name and situation of the lease and the holder thereof].

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 ____, this ____ day of ____, one thousand nine hundred and _, before me—___, Warden, Mining Registrar, Magistrate, Justice of the Peace, Postmaster, or Constable.

*“Gold” includes gold, gold bullion, retorted gold, gold-ores, gold amalgam, gold-alloys, precipitates containing gold, slag, concentrates, tailings, and residues, but does not include coin or things manufactured of gold.

[To be forwarded to the Bank.]

Form 107 (Reg. 173).

APPLICATION FOR A TEMPORARY GOLD-DEALER'S LICENSE.

To the Warden of the ____ Mining District at ____.

I, ___, of ____, do hereby make application in accordance with the provisions of section 411 of the Mining Act, 1926, for a temporary license to deal in gold. My present address for carrying on business is at ____, in the said mining district. I have [not] previously held a license for such purpose.

Dated this ____ day of ____, 19__.

Signature of applicant:

Received this application at ____ o'clock .m. on the day of ___, 19__, with a fee of £1.

____, Warden.

Form 108 (Reg. 174).

TEMPORARY GOLD-DEALER'S LICENSE.

I, ___, being the Warden of the ____ Mining District, do, by virtue of the powers vested in me under section 411 of the Mining Act, 1926, grant to ____ a temporary gold-dealer's license to deal in gold at ____, in the said mining district, and at no other place, for a period of ____ month from the day of the date hereof, and no longer.

Given under my hand, at ____, this ____ day of ____, one thousand nine hundred and ____.

____, Warden.

Form 109 (Reg. 185).

Under the Mining Act, 1926, and its Amendments.

APPLICATION FOR A SERVICE PERMIT AS WELL-MANAGER.

To the Chairman of the Board of Examiners, Mines Department, Wellington.

I, the undersigned [Full name, residence, and occupation], hereby apply for a service permit as well-manager, and hereby declare as follows: That I have had in the aggregate at least three years' practical experience in various capacities at well-operations where gas and oil have been dealt with, and in proof thereof I forward with this application evidence in writing from my previous employers.

Dated at ____, this ____ day of ____, 19__.

Particulars of Employment and Nature of Evidence in Proof thereof:

Name of Country, Locality, and Well-operations.

Name of Employer.

Period of Employment.

Nature of Employment.

Signature of Employer or Well-manager.

Form 110 (Reg. 190).

Under the Mining Act, 1926.

APPLICATION FOR LICENSE TO PROSPECT OR BORE FOR PETROLEUM OR OTHER MINERAL OILS OR NATURAL GAS.

To the Hon. Minister of Mines, Wellington, N.Z.

Pursuant to the Mining Act, 1926, and regulations thereunder, I [Insert full name, occupation, and address], hereby apply on behalf of ____ for a license to prospect or bore for [State whether petroleum or other mineral oils, or natural gas] on the land described in the Schedule hereto and marked on the accompanying plan; and I undertake to carry on all operations under this license, if same be granted, strictly in accordance with the provisions of the aforesaid Act, and the regulations made thereunder.

Dated at ____, this ____ day of ____, 19__.

SCHEDULE.

Insert full description of land, giving area, boundaries, section and block numbers, and names of survey district and county wherein situated, also state whether held under mineral prospecting warrant, mineral lease, or any other title. Give full particulars.

Form 111 (Reg. 191).

Under the Mining Act, 1926.

LICENSE TO PROSPECT OR BORE FOR PETROLEUM OR OTHER MINERAL OILS OR NATURAL GAS.

Pursuant to the Mining Act, 1926, I, the undersigned, ____, Minister of Mines for the Dominion of New Zealand, do hereby grant to ____ this license to prospect or bore for petroleum or other mineral oils or natural gas upon the land specified in the Schedule hereto, and marked upon the plan numbered ____ lodged in the office of the Department of Mines, Wellington, subject to the following conditions:—

(a.) The term of this license shall be ____ years from the date hereof.

(b.) The prospecting or boring operations under the license shall be carried out strictly in accordance with the Mining Act, 1926, and all regulations thereunder shall be complied with.

(c.) If failure to comply in any respect with the aforesaid regulations is reported by the Inspector, this license shall be subject to summary cancellation.

(d.) This license shall carry no inherent right of renewal, but on the expiry of the period of ____ years a fresh license may be granted on application being made in that behalf.

Dated at ____, this ____ day of ____, 19__.

Minister of Mines.

SCHEDULE.

Insert full description of land, giving area, boundaries, section and block numbers, and names of survey district and county in which land is situated, and also state whether held under mineral prospecting warrant, mineral lease, or any other title.

SIXTH SCHEDULE.

TABLE OF FEES.

PART I.

Sums to be lodged with the Receiver in connection with the Filing of the Application, to abide the Disposal of the Application.

1. WHERE rent is payable for the mining privilege or timber-cutting right applied for:—

One half-year's rent computed on the area specified in the application.

2. Where a recurring license fee is or other fee is so payable:—

The amount of the fee.

3. Where a non-recurring license fee or other fee is so payable:—

The amount of the fee.

4. Where survey is necessary:—

Survey fees as per scale as approximately estimated by the Receiver.

5. Where advertising is or may be required:—

The approximate cost thereof as estimated by the Receiver, not exceeding £4.

6. Where registration will be necessary:—

A registration fee of 2s. for each separate registration entry.