The Pamphlet Collection of Sir Robert Stout: Volume 44
Form "B" — Annual Return
Form "B"
Annual Return.
1 State if bush or open land, and if comprised of both kinds, state number of acres of each.
acres, situated in the______Block selected by______on the Date, when selection was taken possession of.
2 Here state in full the names of the persons on whose ac-count the selection has been made.
3 State dimensions of house, materials of which constructed and value.
Dated this_____day of_____187
Witness to Signature._____Signature of Selector.
Note.—If any person holding land as aforesaid shall cease to be in bonâ fide occupation of the same, or fail to effect thereon the Improvement required by the Act, or forward wilfully inaccurate returns, or commit any breach of these Regulations, such person shall be liable, in addition to forfeiture of selection, to a penalty not exceeding £20 for every such breach, default or failure, and all penalties incurred hereunder shall be recoverable in manner provided by the said Act.