559527-1928-Rules-made-by-the-Chief-Justice-under-section-4-of-the-Suitors-Funds-Ordinance-1896 — Page 9

418

THE HONG KONG GOVERNMENT GAZETTE, SEPTEMBER 14, 1928.

SCHEDULE.

Payable to

Amount of taxed costs

Cost of

and fees.

Name.

Address.

TOTAL.........

$

FORM No. 7.

Declaration.

IN THE SUPREME COURT OF HONG KONG.

(Title of cause or matter.

No..........of 192......).

Ledger account (if the same as the cause, state as above").

[Rule 10 (2).]

I (name and address of applicant) solemnly and sincerely declare that I am the (degree of relationship) and next or one of the next of kin of (name of deceased) and that I am entitled to take out administration to his estate and to receive the sum of $...

...directed to be paid to him by the order dated the.......

.19......

....

And I further declare that the total value of the assets of the deceased including the above sum 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 applicant)..

Declared at

Before me this................................day of..............

Dated this 14th day of August, 1928.

I concur.

W. T. SOUTHORN, Officer Administering the Government.

19......

Justice, Notary Public, or other authorised officer.

H. C. GOLLAN,

Chief Justice.