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Form 21 (Eeg. 23). Under " The Mining Act, 1898." Declaration to accompany Application to surrender, WHETHER ABSOLUTELY OR FOR PURPOSES of Exchange, where all or any of the Instruments of Title are lost. In the matter of an application by to surrender certain mining privileges, which application is numbered in the Application Eecord-book at , in the Mining District. I, A.B. [Full name], of [Occupation and address], do hereby solemnly and sincerely declare as follows :— (1.) That I am the applicant [or one of the applicants] named in the above-de-scribed application. (2.) That I have made diligent search for such of the instruments of title referred to in the said application as are described in the Schedule hereto, but cannot find the same, and believe the same to be irrecoverably lost. (3.) That the said instruments have not been lodged or deposited with any person for purpose of security for money or otherwise. And I make this solemn declaration, conscientiously believing the same, under and by virtue of " The Justices of the Peace Act, 1882." THE SCHEDULE ABOVE REFERRED TO. [Set out date and nature of each instrument of title.] Declared at , this day of , 1 , before me— , a Justice of the Peace for the Colony of New Zealand [or as the case may be].

Form 22 (Eeg. 23). Under " The Mining Act, 1898." Declaration where Applicant does not desire to APPEAR. In the matter of an application numbered in the Application Eecord-book at , for [State subject-matter of application]. I, , of , do hereby solemnly and sincerely declare as follows : — 1. That I am the applicant [or one of the applicants] named in the above-described application. 2. That all the statements contained in the said application are true. 3. That all prescribed provisions as to marking out the ground referred to in the said application, serving notices on all persons affected, and otherwise, have been duly observed, in so far as is required by law. 4. That the ground applied for, and referred to in the said application, does not cross any road or street. 5. That the applicant named in the said application believes himself [or believe themselves] to be entitled to the grant of the said application, and knows [or know] of no valid objection thereto. 6. That, so far as I am [or the said applicants are] aware, no public or private rights will be prejudicially affected by the grant of the said application. 7. [Here set out such other facts as may be necessary] . And I make this solemn declaration, conscientiously believing the same to be true, under and by

virtue of the provisions of an Act of the General Assembly of New Zealand intituled " The Justices of the Peace Act, 1882." Declared at , this day of , 1 , before me— , a Justice of the Peace for the Colony of New Zealand [or as the case may be].

Form 23 (Eeg. 45). Under " The Mining Act, 1898." Certificate of Eeservation of Timber Area. This is to certify that, pursuant to application in this behalf, and the provisions of " The Mining Act, 1898," I have this day reserved the area of land described in the Schedule hereto as a timber area for , as the holder of sawmill license registered at as No. , subject to the provisions of the aforesaid Act and the regulations thereunder. This certificate continues in force for one year from the date hereof, but may be renewed from year to year whilst the aforesaid license continues in force, but no longer. There is payable in advance in respect of this certificate, and of each annual renewal thereof, an acreage rental of £ , being at the rate of Is. per acre. As witness my hand, and the seal of the Warden's Court at , this day of , 1 SCHEDULE. [Describe land.] , Warden.

Form 24 (Eeg. 57). Under " The Mining Act, 1898." Eegister of Mining Privileges. At , in the Mining District. Nature, locality, and description of miningprivilege: [E.g., Water-race : Source of supply, the Fraser Biver, about two miles north of the Old Man Bock; course, north-west and south-east; length, about twelve miles; average depth, 10ft.; average breadth, 20ft.] Water authorised to be diverted : [Fifteen heads]. Precise time of filing application for the race : [1 p.m., 14th December, 1899].

Form 25 (Eeg. 68). Under " The Mining Act, 1898." Application to register a Mining Privilege held otherwise than under license. To the Mining Eegistrar of the Mining District, at Pursuant to the provisions of "The Mining Act, 1898," I, A.B. [Name in full], of [Besidence and occupation], being the lawful holder of an unregistered mining privilege described in the Schedule hereto, do hereby make application to register the same, and I hereby declare as follows : — (a.) That I have duly observed all the provisions of the said Act relating to the

o a ■a* © fl Instrument. Date of Instrument, Precise Time of presenting Instrument for Registration. Grantor i Grantee or Trans- ; or Transferor, feree. Names of Parties.