1971-HKRS30-16-30_Part05 — Page 33

4

Hong Kong Identity Card No.

19......... has been registered in accordance with

Fee:

• Delete whichever is not applicable.

Address:

地址

-

Note: This notice must be given to the same designated public officer to whom the notice under section 16(1) of the Ordinance was given. 附註:本通知帶必須送交能此根據該賺例第十六款第(一)段規定之通知書所發

交之指定主管人員。

FORM 10.

MARRIAGE REFORM ORDINANCE.

SECTION 17(2),

第十七款第(二)段

Statement of Designated Public Officer. 由指定主管人目颟耠之聲明竈

(WARNING: This is nor a Certificate of Dissolution of a Marriage). [注意:本聲明書並非解除婚姻褪仴言,

No.

號

Do the

day of

九

年

具

(husband) and

of 19. 年份:一九

19.........

(wife),

(養室)、

who are parties to a "customary/validated marriage, gave me notice in

accordance with section 1601) of the Marriage Reform Ordinance of their 为,就依照襲釘彜嫻菜阕第十六款第 intention to dissolve their marriage in accordance with Part V of the C

Ordinance. The marriage, which took place on the

怨

月 日舉行 兼日佬爾嫌例第四 Part IV of the Ordinance and was subsisting on the appointed day 塵之規定而册,且在指定日期时 九七 年 (7.10.1971). *Both the parties have (One of the parties, namely

-

打 即

口

....... has] a substantial connexion with Hong Kong.

2. I. baving interviewed the abovementioned parties in accordance

with sections 17 and 18 of the Ordinance, hereby state that I am satisfied 之規定接見上述明女方

that.

(a) the notice of intention to dissolve the marriage was given to me

by the abovementioned parties under section 16(1) of the Ordin-

ance and that no notice of changed intention under section 16(2)

was given; and

知逕

(6) the parties understand that the effect of dissolution is to put an

end to the marriage so as to permit them la marry again should

以便在何

曾

gither of them so wish; and

裈婚: K

腻

(c) the parties freely and voluntarily desire to dissolve the marriage.

(丙)雙方均糠自願自勵將婚跺者

Dated this

日期:

Fee: $50.

費用: 五十元

day of

丸

19.........

Designated Public Officer. 相戀主管人員濉器

*Headquarters, Secretariat for Home Affairs/

Headquarters, New Territories Administration?

District Office.

day of

• Delete whichever is not applicable.

理