406
THE NEW ZEALAND GAZETTE.
[No. 14

PART II.
Application for Loan to Acquire a Dwellinghouse.

To the Superintendent, State Advances Office (Advances to Workers Branch),
Wellington.

I, ____, hereby apply for an advance on mortgage under the provisions of the State Advances Act, 1913, and amendments (Advances to Workers Branch), and I enclose 12s. 6d. being the prescribed valuation fee.

I agree to pay on demand the Office Solicitor’s costs and any other costs and expenses whether the transaction be completed or not, and to insure all buildings on the property in the Superintendent’s official name as mortgagee if a loan is granted.

[Signature of Applicant.]
[Occupation.]
[Address.]

1. (a) Have you previously applied to the Department for a loan; and, if so, when?
   (b) Have you or your wife (husband) or any member of your family at any time owned a property on which there was a State Advances loan; and, if so, state particulars?
   (c) Have you or your wife (husband) at any time owned a property mortgaged to another Government Department, and, if so, state particulars?

2. What is amount of loan required (maximum £1,250): £ ____

3. State the largest amount of cash you can find to assist in acquiring the home:

4. (a) Are you married? ____ State age: ____
   (b) If about to be married, state when: ____

5. Is the land freehold or leasehold: ____

6. If leasehold, what is the class of lease (see para. 1 of pamphlet): ____

7. Description of property:—
   (a) No. of section, allotment, and Block No.: ____
   (b) Name of road, street, and local or survey district: ____
   (c) Distance from nearest railway-station, tram, or bus (state which): ____

8. Measurement of frontage to street or road: ____ Depth of land: ____ Area: ____

9. State from whom you acquired (are acquiring) the property: ____
   Date of purchase: ____
   (a) State the amount of the purchase-money: ____ Amount already paid: ____
   (b) Did you purchase under a sale and purchase agreement? ____
   or (c) Have you taken title to the property and given a mortgage for the balance of the purchase-money? ____

10. State what public services, such as water, sewerage, electricity, or gas, are available: ____

11. Where are the title-deeds to be obtained? ____

12. When was the dwelling erected? ____

13. State the amount of insurance on the buildings: ____ Insurance company: ____

14. State annual amount of rates or other charges (exclusive of rent) to which the property is liable: ____

15. State present value of the—

Land unimproved .. .. .. £ : :
Dwellinghouse .. .. .. £ : :
Fencing .. .. .. £ : :
Other improvements .. .. .. £ : :

Total .. .. .. £ : :

16. Sketch-plan showing the boundaries of the property and location of the buildings must be supplied hereunder.

17. Memoranda:

Statutory Declaration.

(Where the applicant is married the Declaration must be made by both husband and wife.)

I, (WE), ____, of ____, do (jointly and severally) solemnly and sincerely declare:—

1. That subject to the provisions of the State Advances Act, 1913 (relating to Advances to Workers), I (we) desire a loan for the sole purpose of acquiring a home for myself (ourselves) and my (our) family.

2. That the replies to the questions in my (our) application for a loan are true and correct to the best of my (our) knowledge and belief.

3. That I, the said [Fill in husband’s full name], am employed as ____ by ____ and my weekly wages are £ ____.

4. That I am (we are) in receipt of an annual income of ____ pounds.

5. That there are dependent on me (us) ____ children or other persons [State names and ages].