1895-HKRS28-1-1-1_Part01 — Page 16

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

Foxx 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 sum of dollars (in words at length]

lodged in Court in the above cause or matter.

*

For No. 6.

Certificate of ascertained Sums referred to in Iule 10.

In the Supreme Court of Hongkong,

[Title of caues or mattor.

Lediger pecount [if the same as the cause state “ns above,"]

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

18

+

No. ]

*

18 the aums stated in the schedule subjoined hereto have been ascermined to be the mums payable under the said Order to the persons respectively named in respect of [state in what character paid].

18

Dated this

of

(Signature.)

Registrar.

SCHEDULE.

Name.

Address (if nscertained).

Amount to be paid.

Form No. 7.

Formal part as in last form.

In pursuance of an Order dated

Certificute of Taxed Costs referred to in Rule 11.

18 I have been attended by the splicitors for

and I certify that I bare texed the coats specified in the schedule subjoinal berets directed to be taxed by the said Order at the aums respectively stated in the schedule, which sums with the fees of taxation specified amount to the total sum of

Dated the

of

18

(Signature.)

Registrar,

SCUEDULE.

Payable to

Amount of Taxel Costs

Costs of

and Fees.

Name.

Address.

Total $

[Formal part as before.]

FORM No. 8.

Declaration referred to in Rule 12 (11).

1 [name and oddress of opplicant] 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 and to receive the

18 sum of $

directed to be paid to him by the Order dated the

And I further declare that the total value of the nssets of the decensed including the above mum does not exceed $500, and I certify that the death-bed and 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 The

Justice, Natury Publie, or other authorized officer.