2204
THE NEW ZEALAND GAZETTE.
[No. 57

9. Every such application shall have attached thereto an invoice (or received invoice) relating to the purchase of motor-spirits to which the application relates :

Provided that in any case the Registrar of Motor-vehicles may require or accept such other or further evidence as he thinks proper relating to the purchase of any motor-spirits.

10. The Registrar of Motor-vehicles may, if in his opinion an application has not been made in proper form or the particulars provided are insufficient, withhold the payment of any refund until such application has been made in proper form to his satisfaction, or until all the particulars which he required have been supplied.

11. Payment of refunds when approved shall be obtainable from the Postmaster of the post-office at which the applicant requests payment to be made if it is a money-order and savings-bank office, otherwise from the Postmaster of the money-order and savings-bank office nearest or most convenient thereto.

SCHEDULE.
(Face of form.)

Motor-spirits Taxation Act, 1927.

APPLICATION FOR REFUND.

To the Registrar of Motor-vehicles (through the local Postmaster).

I [Full name], [Address], [Occupation], do hereby apply for a refund of pounds shillings pence (£ : s. d.), due in respect of the use of gallons of motor-spirits on which exemption at the rate of 6d. per gallon is due under section 8 of the above Act.

The total quantity of motor-spirits purchased and for which invoices were obtained is as follows :—

The motor-spirits were purchased from—

Name of vendor : . (State dates of purchases.)
Name of vendor : . (State dates of purchases.)
Name of vendor : . (State dates of purchases.)
Name of vendor : . (State dates of purchases.)

Quantity of spirits carried over from previous quarter (supporting invoices to be attached) ..

Total .. .. .. ..

and were used for one or more of the following purposes :—

Purposes for which above-mentioned motor-spirits have been used :—

(a) Milking-machinery .. .. .. used during
Cow-capacity of plant : . Number Quarter.
of persons employed in milking : .
Make of engine used : . Horse-power : . Number of cows milked : . Total number of hours in use during quarter : . (1) Milking-purposes, . (2) Other purposes, .
Other purposes for which engine used :

(b) Shearing-machine .. .. .. ..
Make of engine used : . Horse-power : . Total number of hours in use during quarter :

(c) Motor-vehicle* (state whether mule, farm tractor, locomotive, &c.) .. .. ..
Class and make of vehicle : . Horse-power : . Gallons per hour : .
State registration number, if any : .

(d) Launch or other vessel* .. .. ..
Name of vessel : . Regn. No. : .
Make of engine : . Horse-power : .
Number of gallons per hour : .
Hours in use during quarter : .

(e) Other stationary engine .. .. ..
Make : . Horse-power : .
Purpose for which used : . Number of hours used during quarter : .

(f) Aircraft .. .. .. ..
Make : . No. of engines : .
Horse-power per engine : . Number of gallons per hour : . Hours in use during quarter : .

(g) Lighting and heating plant .. .. ..
Make : . Number of points : .

(h) Manufacturing, cleaning, scientific, or other purposes not included above .. ..
State purpose : . Supply particulars in support of quantity of motor-spirits consumed : .

(i) Licensed motor-vehicles used for commercial or private purposes (no refund due) .. ..

(j) Quantity of spirits carried over into next quarterly period .. .. ..

Total .. .. .. ..

I attach hereto invoices for all motor-spirits to which this application refers.

I hereby declare as follows :—

1. That the above statements are true in every particular and include all refunds due to me for motor-spirits consumed during the quarter ended the last day of , 19 .

2. That the motor-spirits referred to were consumed solely and exclusively either—

(a) For purposes other than as fuel for a motor-vehicle in respect of which an annual license fee is payable under the Motor-vehicles Act, 1924 ; or

(b) In an agricultural tractor as defined by the Motor-spirits Taxation Amendment Act, 1928.

3. That the claim is rendered within two months after the close of the quarterly period during which the motor-spirits were consumed.

I desire payment to be made at Post Office.

Declared at , this day of , 19 , before me—

……………, Claimant.

……………
[Justice of the Peace, Notary Public, Solicitor, Postmaster, member of New Zealand Society of Accountants, or person approved by the Registrar of Motor-vehicles to attest.]

Examined and found correct : .

Payment approved : .

For Registrar.

Any person making a claim that is false in any material particular is liable on summary conviction to a fine of £50 or imprisonment for three months.

Received this day of , 19 , from the (Chief) Postmaster the sum of pounds shillings and pence, in full payment of the above claim, also document(s) submitted with application.

……………[Signature].
(Affix here the duty-stamp necessary when the amount is £2 or more.)

£ : : .

(See back hereof.)

• Special declaration to be signed on back hereof.

(Reverse of form.)

Instructions to Applicants.

1. The application on the face hereof must be forwarded quarterly to the Registrar of Motor-vehicles through the Postmaster whose office is nearest to the applicant’s place of business or residence.

2. Every application should cover motor-spirits used during one only of the quarterly periods ending on the last days of March, June, September, and December in any year.

3. Every application must be lodged in accordance with the provisions of subsections (1) and (3) of section 3 of the Motor-spirits Taxation Amendment Act, 1928, as printed below.

4. Claims lodged during the second month after the close of the prescribed quarterly periods are subject to a penalty of 10 per cent., whilst those lodged later cannot be recognized.

5. Proof of purchase of the motor-spirits by the consumer must be attached to the application ; the proof, where possible, to be in the form of the received invoice.

SPECIAL DECLARATIONS.

Agricultural Tractors.

I hereby certify that the agricultural tractor(s) mentioned in the claim overleaf is/are used exclusively for farm work and is/are not used on the roads for haulage purposes other than for the conveyance of farm implements from farm to farm.

……………
Signature of tractor owner.

Local Authorities.

I hereby certify that the motor-spirits on which a refund of duty is claimed were consumed in motor-vehicles (other than motor-cars or motor-cycles) owned by a local authority and used exclusively or principally in connection with the construction or maintenance of roads or streets.

Signed :……………,
Town Clerk, County Clerk, County Engineer, &c.