Form No. 41, Rule 85.—Form of Declaration. Section 13,"Native Land Court Acts Amendment Act 1889."

In the matter of the land known as_____.

I, _____, of_____, do solemnly and sincerely declare that the application to the Chief Judge of the said Court for an inquiry under the provisions of "The Native Land Court Acts Amendment Act, 1889," annexed hereto, and marked A, has been signed by me with my own proper handwriting [or mark], and that the statements therein contained, so far as they relate to my own acts and deeds, are true and correct in every particular, and, so far as they relate to the acts and deeds of other persons, I do verily believe them to be true and correct; and I make this solemn declaration conscientiously believing the same to be true, and by virtue of the provisions of an Act of the General Assembly of New Zealand intituled "The Justices of the Peace Act, 1882."

_____(Signed.

Declared at_____, this_____, day

of_____, 189_____, before me,

Justice of the Peace [or Solicitor, or Notary Public].