Form D.

Notice of Appeal.

To Esquire, Resident Magistrate.

Take notice that Mr. having reported under the First Part of "The Wellington Special Settlements Act 1871" that I have not fulfilled the condition No. 1 of my license to occupy land in the Block dated 18 I hereby appeal against the said report and require you to fix a time and place for hearing the said appeal, and I deposit herewith five pounds as required by the Act.