2920

THE NEW ZEALAND GAZETTE.

[No. 72

[Form No. 1.

REGISTRATION, ETC., BY A VENDOR OF FERTILIZERS.

To the Director-General of Agriculture, Wellington.

PURSUANT to sections 5 and 6 of the Fertilizers Act, 1927, I [we],
being a vendor [vendors] of fertilizers under the said Act,
hereby register my name [our names] and address with you, and apply for registration of the brand [brands] shown in facsimile
below, and I [we] deposit this statement of particulars in respect of every brand of fertilizer which I [we] contemplate selling;
and I am [we are] aware that the said sections require (a) application for registration to be made in the month of June of each
year, or before offering any fertilizer for sale, and (b) that no fertilizer shall be sold under any brand until a certificate of the registration of the
brand has been received in respect of such fertilizer.

Full name [if an individual]:
Trade name [if a firm]:
Business address:

STATEMENT IN RESPECT OF EVERY BRAND OF FERTILIZER TO BE SOLD BY ME [US].

[Form No. 2.

REGISTRATION, ETC., BY A VENDOR OF FERTILIZERS.

(For Fertilizers of which the Full Particulars have been registered
by an Importer, Manufacturer, or Mixer.)

To the Director-General of Agriculture,
Wellington.

PURSUANT to sections 5 and 6 of the Fertilizers Act, 1927,
I [we], being a vendor [vendors] of fertilizers under the said
Act, hereby register my name [our names] and address with
you, and I [we] deposit this statement in respect to every
brand of fertilizer which I [we] contemplate selling; and I
am [we are] aware that the said sections require (a) application
for registration to be made in the month of June of each
year, or before offering any fertilizer for sale, and (b) that no
fertilizer shall be sold under any brand until I [we] have
received a notification that such brand has been registered in
respect of the fertilizer.

Full name [if an individual]:
Full name [if a firm]:
Business address:

STATEMENT IN RESPECT OF EVERY BRAND OF FERTILIZER TO
BE SOLD BY ME [US].

SCHEDULE.

[Form No. 3.

Statement under Section 20 of the Fertilizers Act, 1927, by an
Importer of Fertilizers.

To the Director-General of Agriculture, Wellington.

PURSUANT to section 20 of the Fertilizers Act, 1927, I [we],
, having imported the undermentioned fertilizer for
our own use [as agents for the purchaser], and not for sale or
exchange, hereby deposit with you this statement of particulars in respect to such fertilizer:—

Full name [if an individual]:
Trade name or name of body or association:
Address:

STATEMENT.

Description of fertilizer:—
Nitrogen, soluble ..
Nitrogen, insoluble
Phosphoric acid, soluble ..
Phosphoric acid, insoluble ..
Potash, soluble ..
Phosphoric acid, citric-soluble*

per cent., as
per cent., as
per cent., as
per cent., as
per cent., as
per cent.

• Optional.

The fertilizer contains the following components (including
filler or diluent) in the proportions stated.
Of the above components the fineness of grinding of the
following is as set out opposite each, viz.,
A sample of the above fertilizer has been forwarded to the
Chemist as required by the Act.
Dated this day of , 19 .
[Signature of Importer.]

[Form No. 4.

The Inspector under the Fertilizers Act,
Department of Agriculture,
In accordance with section 8 of the Fertilizers Act, 1927, I
[we] beg to notify you that I [we] have sold to , of
, the undermentioned fertilizer for delivery in bulk :—

Name of vendor:
Place:
Date:

[Form No. 5.

CERTIFICATE OF ANALYSIS OF FERTILIZER.

To , Inspector under the Fertilizers Act.
I, , the undersigned Analyst under the Fertilizers
Act, 1927, do hereby certify that I received on the day
of , 19 , from , by in good condition, a sample of fertilizer, weighing lb. oz., securely
fastened and sealed with seal and marked for
analysis, and declare the results of the analysis to be as
follows:—

Per Cent.
Nitrogen, soluble .. .. ..
Nitrogen, insoluble .. .. ..
Phosphoric acid, soluble .. .. ..
Phosphoric acid, insoluble .. .. ..
Phosphoric acid, citric-soluble .. .. ..
Potash, soluble .. .. ..
Fineness of grinding:

The particulars in the invoice certificate supplied by the
vendor are as follows:—

Description of fertilizer:—
Nitrogen, soluble .. .. per cent., as
Nitrogen, insoluble .. .. per cent., as
Phosphoric acid, soluble .. .. per cent., as
Phosphoric acid, insoluble .. .. per cent., as
Phosphoric acid, citric-soluble .. .. per cent., as
Potash, soluble .. .. per cent., as
Fineness of grinding:
Components .. .. per cent.

And I certify that

Wellington, [Date].

[Signature.]

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