New Zealand: Acts affecting Native Lands, 1886, 1888-91 and 1894-95

Fourth Schedule. — Certificate

Fourth Schedule.
Certificate.

I, the undersigned, A.B., Stipendiary Magistrate, and the Chairman of the Licensing Committee for the District of, do hereby certify that [&c., or otherwise at the circumstances of the case may require].

[Add, where necessary: The fee payable in respect of the license is £, and the same is payable to (name of officer), at (place), on [gap — reason: damged] before the day of, 189.]

C.D.,
Clerk to the Licensing Committee.

A.B.,
[unclear: Stpendiary] Magistrate.