CO129-304 - Governor Sir Blake - 1901 [1-4] — Page 307

$

海

}

Cholosure

132.)

C.O.

302 12410

COLONIAL PENSIONS, &C;

*.

Inca? 9 APR OF

ARTICULARS required to be furnished in reference to Persous recommended for Superannuation,

Compensation or Compassionate Allowances, or Gratuities on retirement.

1. Name of Applicant

2. Office or Situation

3. Recommended for

4. Age.

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

At Drury Executive Engine

Transfer

weer

of $

5. Service in Years and Months/welve years & nine worths.

6. Annual Salary or Wages

Emoluments

Total amount of Salary or Wages and Emoluments on which $

Superannuation, &c. is claimed,.

8. Cause of Retirement.

3000

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

Dute Commence.

of ment. Termination.

Nature

Annual Salary.

Allowances, &c.

of Allowances,

&c.

#208

Carvey

Tom povary Land Ourwayer 184.87 318icino 1800 Avestand Engineer 1 Jan 1891 3/847 2400

31 Jam 1098 901pter 3000

190 Executive In

10 septoe

[C. O. D. No. 3)