Form No. 13, Rule 22.—Application to succeed to Realty. Ki to Kooti Whenua Maori.

Kia mohio koutou. Ko_____, tona Kainga kei_____, i mate i te_____, o nga ra o_____,. Na, he whenua ano tona ko_____, kei te takiwa o_____, kihai taua whenua tukua e ia ki tetahi tangata. Na, he mea atu tenei naku ki a koutou, e whai take ana ahau ki taua whenua. Ko toku kainga kei_____, e tata ana ki

No te_____, o nga_____, ra o_____, 189.

Me tuhituhi tou ingoa ki konei:

_____Na

_____Kai tono.