CO129-151 - Lieut Governor Whitfield - 1871 [7-8] — Page 281

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THIRD SCHEDULE.

Form of Colonial Treasurer's Certificate under Ordinance No. 9 of 1869.

IN THE COURT OP SUMMARY JURISDICTION. Ordinance No. 9 of 1869.

Nature and Particulars of Claims for Crown Rent.

1

2

20

4

5

No. of Crown Lot

Whether Defendant

Name

of

Defendant

Amount Claimed.

in respect of which the Kent is claimed. Term of Lease.

is Original I.cssee,

or Assignee in pos- session by Purchase or Mortgage.

For what Period the

Ront is Claimed,

and when due.

Nature and Particulars of Claims for Police, Lighting, Water, and Fire Brigade Hator.

1

2

2

Nama of Defendant.

No. of Tenement

Amount Clained.

in respect of which Katea Payable.

Whether Defendant is Owner

or Occupier.

For what Period Rates Claimed and when due.

I

Nature and Particulars of Claims for Spirit License Fees.

2

3

Name of Defendant.

Amonni Claimed,

Number, Date and Period of License.

4

Whether

original Licenses or Transferree of License.

5

For what Period,

and whether entire Fee or Instalment, and when due,

I hereby certify that the several Persons whose Names are entered in the First Column of the above Particulars have made default in the Payment to the Crown of the Suns set forth opposite to their respective Names in the Second Column, and that the said Persons are severally liable to the Payment thereof in respect of the Claims, the Nature and Particulars of which are also set forth opposite their respective Names in the Third, Fourth, and Fifth Columns.

Dated the

78

Colonial Treusurer.

278

5