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The Pamphlet Collection of Sir Robert Stout: Volume 27
Third Schedule. — "The West Coast Settlement Reserves Act, 1881."
Third Schedule.
"The West Coast Settlement Reserves Act, 1881."
I, A.B., of [Insert place of abode and occupation], do solemnly and sincerely declare—
| 1. | That I am of the full ago of eighteen years. |
| 2. | That I am the person who, subject to the provisions of "The West Coast Settlement Reserves Act, 1881," is tendering for the purchase [or is desirous of becoming the transferee or sublessee] of a lease of [Here specify land]. |
| 3. | That I am purchasing such lease solely for my own use and benefit, and for the purposes of cultivation, and not directly or indirectly for the use or benefit of any other person whomsoever. |
| 4. | That, including the said lands, I am not the tenant or occupier, directly or indirectly, either by myself or jointly with any other person or persons, of any lands anywhere on the West Coast Settlement Reserves exceeding in the whole six hundred and forty acres of rural land and forty acres of suburban land. |
And I make this solemn declaration conscientiously believing the same to be true, and by virtue of an Act of the General Assembly of New Zealand intituled The Justices of the Peace Act, 1882."
A.B.
Declared at _____, this _____ day of _____, 188, before me, > Justice of the Peace for the Colony of New Zealand [or Solicitor or Notary Public].Note.—This declaration will require a half-crown stump.