1891-HKRS29-1-1-1_Part01 — Page 16

[The formul part as in Form No. 1.]

Fons No. 5,

Direction referred to in Rule 8,

The body of the Direction will be as follows :-

The Treasurer is hereby directed to pay to [here insert the name of person to be paid] the sun of dollars [in words at length]

lodged in Court in the above cause or mutter,

Forx No. 6.

Certificate of ascertained Sums referred to in Rule 10.

In the Supreme Court of Hongkong.

[Title of cause or matter.

as above."]

Lelger account [if the same as the cause state **:

I hereby certify that under Onler dated amounting in the whole to $

18

› No,

1

♥

18 the auras stated in the schedule subjoined hereto have been ascertained to be the sums payable under the said Order to the persons respectively uamed in respect of [state in what character paid].

Dated this

of

18

(Signature.)

Registrar.

SCHEDULE,

Name.

Address (if ascertained).

Amonut to be paid.

Form No. 1.

Formal part as in last form.

In pursuance of an Order dated

Certificate of Taxed Costs referred to in Hule 11.

18

I have been attended by the splicitors for

* and I certify that I bare taxed the costs specified in the schedule subjoined horeto directed to be taxed by the sald Order at

tho auma respectively stated in the schedule, which sumas with the fecs of taxation specified amount to the total sum of

Dated the

of

18

(Signature.)

Registrar.

SCUEDLE.

Payable to

Amount of Texel Costs

Costs of

and Fees.

Name.

Address.

Total $

[Formal part as before.]

Pony No. 8.

Declaration referred to in Rule 12 (ii).

I [name and oddress of opplivant] solemnly and sincerely declare that I am the [degree of relationship] and next or one of the next of kin of [name of deccased] and that I am entitled to take out administration to his estate aud 10 recoïvo the sum of $

directed to be paid to him by the Order dated the

18

*

Aud I further declare that the total value of the assets of the deceaseul including the above snm does not exceed $500, and I certify that the death-bei und funeral expenses of the deceased have been paid. And I make this solemn declaration conscientiously believing the same to be true and by virtue of the provisions of "The Statutory Declarations Act 1835,”

(Signature of Applicaut.)

Declared at

Before me this

of

18

Justice, Notary Public, or other authorized officer.