[O. S. 0. 288] (C. 8, 86.)

632

46948

REC

REG 2 OCT 16)

COLONIAL PENSIONS, &c.

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

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

1. Name of Applicant on NI Mitchell Innes..

Colonial Treasurer.

Pension

2. Office or Situation

3. Recommended for

4. Age..

$7.

5. Service in Years and Months

4. Annual Salary or Wages

7. Emoluments......

.of $.

15

5 Year

H1 months.

$...4. dos 4800

4.doc.

Total amount of Salary or Wages and Emoluments on which

which } $ 4. doo.

Superannuation, &c, is claimed,

8. Cause of Retirement

Transferred & Home Curi ( Service 1.12.18

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-

Date

of

Annual

Allowances,

ment.

Termination, Salary.

&c.

Nature of Allowances,

&c.

Casit

1.1.81 13.7.84 1,200 57 Teachers alle

Quartive.

Rost. Reg. Par.

14.7.84 31/1290 3,24/0

Col. Treasurer 1.1.91 30.11.96: 4, don

[C. O. D. No. 3]

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