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

Form No. 45

Form No. 45.

Certificate of Court Under Section 67.

In the Native Land Court, New Zealand.

In the matter of "The Native Land, Court Act, 1894," and of the application of for a certificate under section 67 of the Act in respect of the survey [or subdivisional survey] of [name of block or subdivision].

At a sitting of the Court held at on the day of, 189, before, Esq., a Judge of the said Court:

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It is hereby certified that the sum of £ is due and owing to in respect of the survey [or subdivisional survey] of the land known as, containing, in the Provincial District of.

As witness the hand of, Esq., Judge, and the seal of the Court, this day of, 189.