Maughing.
W:53.
14th March, 1877
Administrator
J. Gardiner Austin Austin
to
The Right Honorable
The Earl of Carnarvon
SUPERANNUATION ACT OF 1859,
977
316
PARTICULARS required to be furnished in reference to Persons recommended for Superannuation, Compensation or Compassionate Allowances, or Gratuities on retirement.
1. Name of Applicant. Alfred 2. Office or Situation. Warden. 3. Recommended for. Superannuation 4. Age 5. Service in Years and Months 37 years 6. Salary or Wages (average for the last...) £268 7. Emoluments Quarters £37 0 6.8 Total amount of Salary or Wages and Emoluments, on which Superannuation, &c., is claimed. £308Victoria Gaol Warden Grey
Refrate revignation of and tawrent paper in connection with his Pension - claimed
#. Hare state the description of allowance for which the applicant is recommended, viz., Superannuation, Compensation, Compassionate Allowance, or Gratuity. In the case of persons claiming under the 4th Clause of the Act of 1850, this should be stated, and reference should be made to the Warrant or Order under which the claim is made.
If the Service has been interrupted by one or more breaks, the word "broken" should be added before or after the number of years and months, the causes, dates, and circumstances of the break or breaks should be stated on the second page of the form under heading 9.
If the person retiring has been in receipt of the same salary, or in the class from which he retires, for three years immediately before the date of his retirement, the actual annual rate of salary or wages at that date should be inserted, preceded by the word "actual" In other cases the average annual amount of salary or wages for the years next preceding the date of retirement should be inserted, preceded by the word "average," but if the whole period of service is less than three years, then the average for the whole period of service should be inserted.
A separate statement should be inserted of the average annual value for the last three years of each emolument (exclusive of salary or wages) which is claimed to be included in the calculation of the pension or gratuity.