Oct. 10.] THE NEW ZEALAND GAZETTE. 2789

form numbered 1 as heretofore prescribed may continue to be
used at any time until and including the 31st day of March,
1936 :—

Form No. 1.] [File No. (for use
in Registrar’s Office).]

NOTIFICATION OF OWNERSHIP OF MOTOR-VEHICLE (OTHER
THAN TRACTION-ENGINE) THE MOTIVE POWER OF WHICH
IS NOT WHOLLY DERIVED FROM MOTOR-SPIRITS.

To the Registrar of Motor-vehicles, Wellington (through the
Deputy Registrar at ).

PURSUANT to the provisions of section 4 of the Motor-vehicles
Amendment Act, 1934–35, I hereby give notice that the
owner mentioned below—

(a) Is the owner of
(b) Has imported
(c) Has converted so as to use other motive power than
motor-spirits
the undermentioned vehicle :—
Make of vehicle : Chassis No. .
Type of vehicle : [Car, truck, omnibus, trolley-omnibus, &c.]
Classification for purpose of collection of heavy-traffic fees :
[Class A, B, C, &c.]
Make of engine : H.P. . Engine No. :
[Manufacturer’s Rating.]
Motive power derived from [Power-kerosene, electricity, crude
oil, steam, &c.]
Whether plied for hire : [State “ Yes ” or “ No.”]
Seating accommodation (inclusive of driver) :
If imported or converted, state date of arrival in New
Zealand or conversion : , 193 .
The vehicle is at present registered under No. .
The vehicle is at present garaged at : [Address of garage.]
Full name of owner : .
Occupation of owner : .
Postal address of owner : .
Business address of owner : .
Full name of person giving notification : .
Capacity of person giving notification : [Owner, partner,
general manager, secretary, or as case may be.]
I hereby certify that the above particulars are correct.
Signature of person giving notification.
Date : .

8. The form numbered 2 in the Schedule to the principal
   regulations is hereby revoked, and the following form sub-
   stituted ; provided, nevertheless, that a declaration in the
   form numbered 2 as heretofore prescribed may continue to
   be used at any time until and including the 7th day of April,
   1936 :—

Form No. 2.] [File No. (for
Registrar’s use).]

DECLARATION AS TO MOTOR-VEHICLES THE MOTIVE POWER
FOR WHICH IS NOT WHOLLY DERIVED FROM MOTOR-SPIRITS.

PURSUANT to section 4 (3) of the Motor-vehicles Amendment
Act, 1934–35, I hereby declare that the motor-vehicle(s)
owned by , the particulars of which are shown on
back hereof, was used on public roads or streets during the
month of , 193 ; and do also declare that the said
particulars are true and correct.
Full name of person making declaration : .
Capacity of person making declaration : [Owner, partner,
general manager, secretary, or as case may be.]
Signature of person making declaration.
Declared at , this day of , 193 ,
before me— (Justice of the Peace, Postmaster,
Solicitor, Notary Public.)

NOTE.—Declarations must be made and tax indicated paid
on or before the 7th of each month. Penalty for failure :
10 per cent. of the tax payable for the first week’s delay or
part thereof, and 5 per cent. of the tax payable for each week
or part thereof thereafter. (Any person who makes a false
declaration is liable on conviction to a fine of £100.)

Schedule of Tax payable.
£ s. d. £ s. d.
Gross amount of tax payable ..
Plus penalties for late payment ..
Less deduction, if any .. ..
Net amount of tax payable .. ..
This amount accounted for, Receipt No. .
Initials of Receiving Officer.
(Date-stamp of receiving office.)

[Back of form.] PARTICULARS OF DECLARED MOTOR-VEHICLES AS PER FRONT HEREOF.

(1) Make of Vehicle.

(2) Chassis No.

(3) Registration No.

(4) Classification for Pur-
pose of Collection of
H.T. Fees (Class A,
B, C, &c.).

(5) Motive Power derived
from (Power-kero-
sene, Electricity,
Crude Oil, Steam,
&c.).

(6) Mileage Record
reading after com-
pleting running on
Last Day of Month
in respect of which
Declaration is made
was (Number)
of Miles).

(7) Mileage Record
reading before com-
mencing running on
First Day of Month.

(8) Mileage during Month
covered by Return
(Number of Miles).

(9) Mileage run other than
on Public Roads or
Streets during the
same Month (Num-
ber of Miles).

(10) Total Taxable Mileage
for Vehicles sepa-
rately (Number of
Miles).

(11) Gross Amount of Tax
payable.

(12) Penalty payable (if any).

(13) Rebate (if any).

(14) Net Amount of Tax
payable.

Totals :

9. The Schedule to the principal regulations is hereby
   amended by adding thereto the following additional form :—

Form No. 3.] [File No. (for use
in Registrar’s Office).]

NOTIFICATION OF CONVERSION OF ENGINE IN MOTOR-VEHICLE
THE MOTIVE POWER OF WHICH WAS NOT PREVIOUSLY
WHOLLY DERIVED FROM MOTOR-SPIRITS.

I hereby declare that the engine fitted to motor-vehicle
Registration No. .

• (a) Was converted on the [State date], and that the
  vehicle will, in future, be propelled solely by means
  of power derived from motor-spirits ;

† (b) Ceased using fuel other than motor-spirits on the
[State date], and that the vehicle will, in future, be
propelled solely by means of power derived from
motor-spirits.

Full name of owner : .
Full name of person making declaration : .
Capacity of person making declaration [Owner, partner,
general manager, secretary, or as case may be] : .
Signature of person making declaration.
Declared at , this day of , 193 ,
before me— (Justice of the Peace, Postmaster,
Solicitor, Notary Public.)

NOTE.—A declaration on forms numbered 2 or 3 must be
made and the appropriate amount of tax paid in respect of
the mileage run by the vehicle mentioned above during that
portion of the month preceding the date on which this
declaration is lodged with a Postmaster.

(Date-stamp of Receiving Officer.)

• Delete entry not applicable. † Complete either (a) or (b).

C. A. JEFFERY,
Clerk of the Executive Council.

(TT. 9/12/2.)