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The Pamphlet Collection of Sir Robert Stout: Volume 71

Declaration on applying for a Lease under "The Land Act, 1892," an "The Cheviot Estate Disposition Act, 1893."

Declaration on applying for a Lease under "The Land Act, 1892," [unclear: an] "The Cheviot Estate Disposition Act, 1893."

I, A, B,____do solemnly and sincerely declare,—
1.That I am of the age of seventeen years and upwards.
2.That I am the person who, subject to the provisions of "The [unclear: Land] Act, 1892," am applying for a lease of land forming part of the [unclear: Cheviot] Estate.
3.That I am acquiring such lease solely for my own use and [unclear: benefit] and not directly or indirectly for the use or benefit of any other person [unclear: or] persons whomsoever.
4.That, including the lands now applied for, I am not the [unclear: owner] tenant, or occupier, directly or indirectly, either by myself or jointly with any other person or persons, of any lands anywhere in the colony [unclear: exceeding] in the whole 640* acres of first-class land.
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And I make this solemn declaration conscientiously believing the same to be true, and by virtue of an Act of the General Assembly of New Zealand intituled "The Justices of the Peace Act, 1882,"


Declared at,____this____day of____, 189, before



A Justice of the Peace in and for the Colony of New Zealand.