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The Pamphlet Collection of Sir Robert Stout: Volume 60

Schedule G

Schedule G.

To the Auckland District. A.O.F.

We, the Officers of Court_______, hereby certify that Bro._______joined our Court by_______on the_______day of_______188, and that he died on page 52

Schedules.

The______day of______188______, as stated in the certificate attached.

And we further certify that the said Bro.______did not at the time of his death, or for four weeks prior to his death, owe to our Court more than fourteen weeks' contributions, nor has he or this Court in any way forfeited their claim to the Funeral Money allowed by the District.

This Court having advanced the Funeral pay on account of the District, in conformity with District Laws, hereby make application for the repayment of the sum of £

Dated this______day of______, 188 . ______Chief Ranger. ______Sub-Chief Ranger. ______Secretary. Seal of the Court:

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