2

3

Cause of Retirement, [with annexed Medical Certificate, if from infirmity of mind or body, and under 60],

Bad Health.

Statement in terms of sec. viii of the Superannuation Act, of 1859, that the Applicant "has discharged his duties with diligence and fidelity, to the satisfaction of the Head Officer or Officers of his Department," to be signed by any two of such Head Officers, if there shall be more than one, or by such Head Officer, if there should be but one, together with "such a statement as will exhibit the merit, and value, and labour of the services of the Person recommended, embra- cing as long a period of his public service as can be authentically stated," together with obser- vations as to Special Services, Suspension, Reprimand, &c., with full particulars of any injuries received on duty, or other claims or matters for consideration.

416

Dates of Commencement and Termination of the several Appointments held by Applicant, with their Emoluments, distinguishing Salary from other Allowances, and specifying such

Allowances.

£500. 23. 10199 Assistant Surveyor General from 25th September 1843, to 19th June 1844, on £ 500. Acting Surveyor General from 20th Jame 1844, to 12th July 1846, on £1,000. Assistans Surveyor General from 13th July to 27th November 1846,on £ 5.00. Surveyor General from 28th November 1846 1031 July, 1860, on £ 800. 1. August 1860 to 28th April 18by, on £1,000. and since the latter cali, being absent on leave, on half the salary' of the Office.

*

Whether holding any other Public Appointment, or receiving or claiming to receive any Public

Money by Compensation, Half Pay or otherwise.

Received since the year 1856, whiler present in the Colony, an allowance of £200 per annum from the Foreign Office for his services under that Department.

Absences during each of the last 10

years

NUMBER OF DAYS.

YEAR

Illness

Other cause

18 $6,

320

Date of Cessation of Duty

1867,

231

28th April, 18b4

1858.

1859,

Date of Cessation of Salary

1860,

28th April, 1865.

1867,

1862,

1863.

18 by,

1865,

247

118

carcer

Naving personally a full and intimati Knowledge of Mr Cleverly's entire official This first half year excepted) I am able to stati

thas he has invariably discharged his duties with diligence and fidelity and that the Government of this Colony has reason to be satisfied with his public conduct in every particular.

Hougstong.

April, 1865.

Sthl

Wenurm

EX

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