1. 132.)

Enclosure 1.

COLONIAL PENSIONS, &c.

20059

PARTICULARS required to be furnished in reference to Persons recommended for Superannuation, Compensation or Compassionate Allowances, or Gratuities on retirement,

Name of Applicant

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

W. Z. Weillen

2. Office or Situation Warder, Victoria Gaol.

3. Recommended for Gratuity

4. Age 37 years and 7 months.

5. Service in Years and Months 16 year and 1 month

6. Annual Salary or Wages $96.00

THE 15 SEP 17.

7. Emoluments... Total amount of Salary or Wages and Emoluments on which Superannuation, &c. is claimed,

$768

8. Cause of Retirement Ill health.

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 Commencement Date of Termination Nature of Allowances, &c. Annual Salary Allowances, &c. Warder 22.11.95 11.8.97 $96 16.3.01

[C. O. D. No. 18]

160-2.3.01.

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