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The Pamphlet Collection of Sir Robert Stout: Volume 7

No. Form A. — Application for Land on Deferred Payments

No. Form A.

Application for Land on Deferred Payments.

To the Commissioner of Crown Lands for the Province of Wellington.

I hereby apply to purchase acres of land the particulars page 27 whereof are hereunto annexed, under the provisions of the First Part of "The Wellington Special Settlements Act 1871."

Name in full
Date 187.

Number of Acres. Locality and particular description of Land. How paid for.
Deposit with this application £
2nd instalment paid £
3rd instalment paid £
4th instalment paid £
5th instalment paid £

Entered in the Register of Applications this day of 187.