The Pamphlet Collection of Sir Robert Stout: Volume 76
Declaration
Declaration.
I,___, of___,___, do solemnly and [unclear: sincerely] declare,—
1. That I am of the age of twenty-one years and upwards.
2. That I am the person who, subject to the provisions of "[unclear: The] Land for Settlements [unclear: Act], 1894," "The Land for Settlements An Amendment Act, 1896," and the regulations made thereunder, [unclear: as] applying for one of the small grazing-runs described in the [unclear: foregoing] application.
3. That I am acquiring such lease solely for my own use [unclear: and] act benefit, and not directly or indirectly for the use or benefit of [unclear: any] other person or persons whomsoever.
4. That I am not, directly or indirectly, either by myself or [unclear: jointly] with any other person or persons, the owner, tenant, or occupier [unclear: of] any land whatsoever under "The Land for Settlements Act, 1894," or its amendments, nor the owner in fee-simple, nor the tenant [unclear: or] occupier under a lease for a term whereof not less than two [unclear: years] are unexpired, of any other laud in the colony which, with [unclear: the] largest run included in the foregoing application, would [unclear: exceed] 5,000 acres.
5. That the total value of all the real and personal [unclear: property] owned by me does not (after deducting the encumbrances [unclear: thereonly] exceed one and a half times the capital value (exclusive of [unclear: buildings] of any run comprised in the foregoing application.
6. That my answers to the foregoing questions (Nos. 1 to 11) [unclear: are] true and correct in every particular.
And I make this solemn declaration conscientiously believing [unclear: the] same to be true, and by virtue of an Act of the General Assembly [unclear: of] New Zealand intituled "The Justices of the Peace Act, 1882."
(Signature in full.)
Declared at___, this day of___, one thousand___, before me—(Signature),___A Justice of the Peace in and for the Colony of New Zealand (or as the case may be).
Received on___, at___Commissioner of Crown Lands.
By Authority: John Mackay, Government Printer, Wellington.—1899.
[2,500/1/99-[unclear: 38]