1

Enclosure 2

C. 617

9

COLONIAL PENSIONS, &c. 5912

RECY

PEGE 7 A HE

PARTICULARS required to be furnished in reference to Persons recommended for Superannuation,

Compensation or Compassionate Allowances, or Gratuities on retirement.

1. Name of Applicant.

(In filling up this Paper refer to the Instructions on page 4.)

Jos: J

J. Chapman

2. Offere or Situation at Turnkey in Victoria fare.

3. Recommended for,

a pension

of $ 2 £2

4. Ago.

5. Service in Years and Months Mens

6. Annual Salary or Wages

7. Emoluments

Quarless

and su

Achiat

Total amount of Salary or Wages and Emoluments on which

Superannuation, &c., is claimed,..

8. Cause of Retirement.

Mwalided

120

$840.

9. Dates of Commencement and Termination of the several Appointments held by Applicant, with their

Emoluments, distinguishing Salary from other Allowances and specifying such Allowances.

Title of Appointment.

Date of Commence- went.

Date of Termination.

Salary.

Allowances, &c.

Nature of Allowances,

&e.

Celoria Gav E.

1874

urkey, 2nd Class 8 Jany

8

432

Free quarter

July

ん 80

J

1979

Head Turkey 6 June

199

V July

1857

Deer/3 Ayt

ه که

boo

720

20

११६

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