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[Collected Rules and Regulations of the Native Land Court, in English and Māori]

Form No. 31

Form No. 31.

Declaration by Native Alienating Land.

In the matter of "The Native Land Court Act, 1894"; and in the matter of the application of, of, in the Provincial District of, in the Colony of New Zealand, for a confirmation order.

I,, of, in the Provincial District of, in the Colony of New Zealand, an aboriginal native, do solemnly and sincerely declare—

1.That I am the named in a certain deed of, dated the day of, 189, made between, produced and shown to me at the time of my making this declaration.
2.That the statement in the Maori Ianguage of the effect of the said deed, certified as correct by, licensed interpreter, was indorsed on the deed, and was read over to me by the said interpreter [or by, licensed interpreter] before I signed the deed; and he at the same time orally explained to me the effect of the deed.
3.That no spirituous liquors, arms, or warlike stores formed the consideration, or part of the consideration, for the said deed, or are to be received by me.
4.That the sum of has been duly paid to me by the as and for [my share of] the considaration of the said deed.
5.That the land dealt with in the said deed of is not held in trust for the benefit of any Native community.page 42
6.That I have sufficient land left for my occupation and support: namely, acres at, and acres at.
7.That I perfectly understand the nature of the said deed, as explained to me as aforesaid, and that I have no complaint to make regarding this transaction.
8.That [Here state nature of title, whether Crown grant or otherwise].

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," and its amendments.

Made and subscribed at, in the Provincial District of, in the Colony of New Zealand, this day of, in the year of our Lord 189, before me, one of Her Majesty's Justices of the Peace in and for the said colony, the same having been first read and translated to the declarant in my presence by, a licensed interpreter, when the declarant seemed perfectly to understand the same.