Declaration.

To be made quarterly, before a Magistrate or Justice of the Peace, by Teachers and Assistant-Teachers of Undenominational Public Schools and District Boarding-Schools.

I,______, teacher of the Undenominational public school or of the Boarding-School at______, do hereby solemnly and sincerely declare that I have actually and bonâ fide received to my own use, and for the discharge of my duties as public teacher, the sum of______, being the Government grant in aid of my salary for the period of______months, viz, from______to______, and the sum of______, being the share of the stipulated salary due to me from the managers of the Undenominational public school or of the Boarding-School at______for the same period of______months; and that I have enjoyed the free use of a residence provided by the managers [or], that I have actually and bonâ fide received, in lieu of a free residence, the sum of______, being house allowance for the same period of______months; and I make this solemn declaration conscientiously believing the same to be true, and by virtue of the Ordinance No. 6, 1845, intituled "An Ordinance for substituting Declarations in the place of Certain Oaths, and for the suppresion of Voluntary and extra-judicial Oaths and Affidavits."