REGULATIONS UNDER THE LAND TAX ASSESSMENT ACT 1910-1911.
I, THE GOVERNOR-GENERAL in and over the Commonwealth of Australia, acting with the advice of the Federal Executive Council, do hereby make the following Regulations under the Land Tax Assessment Act 1910-1911 to come into operation forthwith. Such Regulations shall supersede the Provisional Regulations under the said Act.
Dated this Fifth day of July, One thousand nine hundred and twelve.
DENMAN,
Governor-General.
By His Excellency’s Command,
ANDREW FISHER,
Treasurer.
____________
PART I.—INTRODUCTORY.
Short Title.
1. These Regulations may be cited as the Land Tax Regulations 1912
Section 1 - Land Tax Regulations 1912 - Land Tax Regulations 1912 | Zoe
Definition.
3. In these Regulations “the Act” means the Land Tax Assessment Act 1910-1911.
PART II.—RETURNS.
Land-owners’ Return.
4. The return of land and particulars required by the Act or Regulations to be made—
(a) By or on behalf of any taxpayer or person owning land wholly included in any one State shall be in the Form A in the Schedule.
(b) By or on behalf of any taxpayer or person owning land in more than one State shall be in the Form B in the Schedule.
C.2548.—Price 1s.
Supplementary Returns.
5. Landowners who have furnished full returns for any year in the forms required by Regulations 4 (a) and (b) shall in the two succeeding years, in lieu of an annual return in Form A or B in the Schedule, furnish a statement in Form C1 or C2 in the Schedule, as the case may be, which shall be delivered to the Commissioner or Deputy Commissioner as the case requires.
6. Any person required to make returns under these Regulations who, in severalty, owns land wholly included in any one State, and, in addition, holds shares in a company which owns land in any other State, shall furnish a return in Form A in the Schedule in respect of the land owned in severalty only, but shall state in such return the names of the companies and the numbers of shares held in them by such person.
7. When returns are furnished in accordance with sub-clause (b) of Regulation 4, the particulars of all land situated in any one State shall be shown in the return grouped together with each distinct parcel separately described and valued. A copy of each of such groups of particulars shall be furnished with the return on separate sheets.
8. (1) Returns made in Form A shall be forwarded to the Deputy Commissioner for the State in which the land is situated.
(2) Returns made in Form B shall be forwarded to the Commissioner at Melbourne.
9. For the purpose of these Regulations, the Northern Territory shall be deemed to be in the State of South Australia, and the Territory of the Seat of Government to be in the State of New South Wales.
Returns by Persons other than Taxpayers.
10. (1) The Commissioner may, by notice in the Gazette, require all persons who, on the 30th day of June last past, were owners of land of a total unimproved value of an amount specified in the notice or upwards (not being less than £3,000) to furnish the returns which by the Act are required to be furnished by taxpayers.
(2) Such returns shall (except so far as is otherwise specified in the notice) be furnished in the manner and within the time prescribed with regard to returns made by taxpayers.
Time for Delivering Returns.
11. Returns for the purposes of the assessment and levy of Land Tax for each financial year after the financial year 1910-1911, shall be delivered to the Commissioner or the Deputy Commissioner for the State, as the case requires, on or before the 31st day of August in each year. Provided that nothing in this Regulation shall limit or affect the power of the Commissioner to require returns of land or other particulars at any other times.
Signature of Returns.
12. Every return shall be signed by the owner, and, if he be unable to write his name, his signature, which shall be made by his mark, shall be attested by a witness, who shall sign as such.
Returns by Companies.
13. (1) The Commissioner may, by notice in the Gazette, require any or all Companies (whether taxpayers or not) to make either or both the following separate returns:—
(a) A return for all the land owned by the Company; and
(b) A return setting forth names and addresses of the shareholders of the Company as at the 30th June then last past and the number of shares held by each shareholder on that date.
(2) Such returns shall (except so far as is otherwise specified in the notice) be furnished in the manner and within the time prescribed with regard to returns made by taxpayers.
(3) Nothing in this Regulation shall affect the liability of a Company to make any return required to be made by the Act or by any other Regulation.
Partnership Returns.
14. (1) Partnership returns shall be made by any partner resident in the Commonwealth.
(2) Where there is no partner resident in the Commonwealth, then the return shall be prepared and delivered for such partners jointly by their agent, manager, or chief representative resident in the Commonwealth.
(3) Each partner must also make a separate return in his own behalf, including his interest in such partnership.
Returns by Agents for Absentees.
15. When a return is made by an agent for any person or persons absent from or not residing in any State or Territory under the authority of the Commonwealth the agent shall make the following returns:—
(a) A separate return for each separate partnership or joint ownership represented by him.
(b) A separate return for each person represented by him, including the several members of any partnership or joint ownership, represented by him.
Returns by Trustees as Trustees.
16. A trustee shall make the following separate returns:—
(a) For each separate trust represented by him.
(b) For trusts represented by him which are liable to be jointly assessed.
Returns by Joint Owners.
17. Joint owners shall make the following separate returns:—
(a) For the joint ownership, to be signed by one of the joint owners.
(b) By each joint owner for his separate interest in the joint ownership, including any other land owned in severalty by him.
Statement of Value in Returns.
18. Fractions of pounds should be omitted in giving particulars of values in any return.
A 2
Address to be Furnished.
19. Every person shall give upon every return his postal address for service of notices, &c., and shall give notice of any change in such postal address within one calendar month after such change, and in default shall not be permitted to avail himself of the fact of such change of address in defence in any proceedings which may be instituted against him for any breach of the Act or Regulations.
Returns and Notices—How to be Furnished.
20. All returns and notices required under the Act or Regulations shall be furnished to the Commissioner or to the Deputy Commissioner, as the case may be, either by delivering them at the proper address on or before such day as may be notified or prescribed, or by posting them so that in the ordinary course of post they would be delivered at the proper address on or before that day.
Postage on Returns.
21. Every return or statement addressed and posted to the Commissioner or to a Deputy Commissioner of Land Tax must bear the proper postage.
Failure to Furnish Returns.
22. No person who is required to furnish a return shall be exempted from any penalty he may have incurred by failure to do so by reason of his not having received personal notice to furnish. The return, or by reason of his not having been supplied with a form of return; but every such person shall himself obtain all forms of returns which he is required to furnish.
Owner to give Notice of Change of Ownership.
23. Every person required by these Regulations to furnish returns shall within one month after contracting in writing to acquire or part with ownership of land send notice to the Commissioner or to the Deputy Commissioner for the State, as the case may be, in Form D, E, or F in the Schedule, as the case requires.
Special Form of Return.
24. (1) The Commissioner may require or accept a special form of return when, in his opinion, special circumstances render it desirable.
(2) All returns required by the Act and Regulations to be furnished shall be in the prescribed form, but the Commissioner may accept a return in a substantially similar form to the prescribed form.
Lessee to give Notice of Acquisition of Land by Lease.
25. Every person required by these Regulations to furnish returns shall, within one month after acquiring land by lease, send notice of the acquisition to the Commissioner or to the Deputy Commissioner for the State, as the case may be, in Form G in the schedule.
Additions to Forms.
26. The Commissioner may cause to be written into any returns such additions to or corrections in information contained therein as he may think fit. Such additions or corrections shall be made in different coloured ink from that in the return, and shall be initialed by the person making them.
Notation on Returns
27. The Commissioner may cause to be written on any return such observations and directions as he may think fit.
PART III.
Payment of Taxes.
28. Taxes may be paid at the office of the Commissioner or of the Deputy Commissioner in any State in any of the following modes:—
(a) By cash, or bank notes, or cheques.
(b) By direct remittance by bank draft or cheque, or post office order or postal note, payable in the Capital city of the State, for the net amount payable.
29. The Commissioner or Deputy Commissioner, as the case may be, shall credit taxpayers with the net amount only of taxes received, and shall first deduct from any remittance the amount of any charge by way of exchange or duty stamp upon any remittance, and the amount of postage and surcharge paid upon any unstamped or insufficiently stamped communication received through the general post from any taxpayer.
30. Except with the express consent of the Commissioner, no money shall be received on account or in part payment of Land Tax.
31. When payment or remittance is made by cheque, the Tax shall not be deemed to be paid, notwithstanding any receipt given therefore, until the amount of such cheque has been collected.
PART IV.
Appeals against Land Tax.
32. The appeal which may be made by any taxpayer or person under Section 44 of the Act must be made to the Court within thirty days from the date of the service by post or otherwise upon such taxpayer or person of the notice of assessment of Land Tax, and at the time the appeal is made a copy of the notice of appeal must be sent by such taxpayer or person to the Commissioner, or to the Deputy Commissioner for the State, as the case may be.
33. Copies of all appeals against assessments shall be delivered to, or posted so that in the ordinary course of post they would be delivered to the Commissioner or to the Deputy Commissioner for the State, as the case may be, not less than sixty days before the date of the hearing of the appeal by the Court.
34. A notice of appeal shall be in form number 1 in the Schedule.
35. The Commissioner may, after receiving notice of appeal, alter the assessment in accordance with the requirements of such notice, and may, not less than fourteen days before the day fixed for the hearing of the appeal, give notice of such alteration to the appellant, and thereupon the appeal shall be determined.
36. The Commissioner may, after receiving notice of appeal, reduce the assessment, and may, not less than fourteen days before the day for the hearing of the appeal, give notice of such reduction to the appellant, who may, not less than seven days before the day of hearing, give the Commissioner notice that he accepts the assessment as reduced, and thereupon the appeal shall be determined. If the appellant does not give such notice, the assessment as reduced shall be deemed to be the assessment appealed against.
37. No appeal shall be allowed in respect of which no copy of notice of appeal has been forwarded within the period limited.
38. The appellant shall be restricted on the hearing of any appeal to the grounds stated in the notice of appeal.
39. Every notice of appeal shall, in addition to the other matters required to be stated therein, also state in what Court of Appeal the taxpayer desires, in default of settlement, that his appeal be set down for hearing.
Objection in lieu of Appeal.
40. (1) Where a taxpayer is dissatisfied with his assessment, but does not desire to appeal to the Court, he may, within thirty days from the date of service by post or otherwise upon him of notice of assessment of Land Tax, state his objections in writing to the Commissioner or to the Deputy Commissioner of the State, as the case may be, on the form provided. The objections shall be considered, and may be allowed, either wholly or in part, and the assessment may be altered or amended accordingly.
(2) Written notice of the decision of the Commissioner or of the Deputy Commissioner, as the case requires, upon such objections shall be given to the taxpayer. If within thirty days after the date of such written notice, or such further period as the Commissioner or the Deputy Commissioner may allow, the taxpayer does not ask that the objection should be treated as an appeal, the right to appeal to the Court shall lapse.
(3) All objections which may be treated as appeals shall be transmitted to the Court of Appeal selected by the taxpayer as formal appeals, and the person making the objection shall be so informed.
Formal Defects not to Vitiate.
41. No assessment, warrant, notice, authority, or proceeding which is, or purports to be, made given or effected under the Act or Regulations, shall be void or voidable for want of form, or be impeached or affected by reason of any mistake, defect, or omission therein, if it is in substance and effect in conformity with the Act or Regulations, and if the person or property concerned is indicated therein with reasonable sufficiency.
PART V.—MISCELLANEOUS.
Public Officers of Companies.
42. Notice of the appointment of a Public Officer of any Company liable to make returns under these Regulations must be lodged with the Commissioner in the case of a Company owning land in more than one State, and with the Deputy Commissioner of the State in the case of a company owning land in one State only.
Provided that in the case of a Company becoming liable to render returns for the first time in any year after the financial year in and for which the first general assessment was made, notice of the appointment of a Public Officer must be lodged not later than the 31st August in the year in and for which the first return by the Company of land owned should be made.
43. When the position of Public Officer of a company becomes vacant, a fresh appointment must be made by the Company within one month after the vacancy arises, and notice of the fresh appointment must be immediately forwarded to the Commissioner or to the Deputy Commissioner, as the case requires.
Evidence, etc.
44. A copy, certified under the hand of the Commissioner or a Deputy Commissioner, of any assessment, return, list, declaration, or statement, or of any book, document, or writing of any nature whatever in the custody of the Commissioner or a Deputy Commissioner or any officer appointed under the Act, shall for all purposes be primâ facie evidence of the contents of the original of which it purports to be a copy.
45. The printed or stamped signature of the Commissioner or a Deputy Commissioner shall, in all cases, be sufficient, and any book, document, or writing bearing, or purporting to bear, his signature, either in writing or printing, or by stamp, shall, unless and until the contrary be shown, be deemed to have been duly signed by him, and judicial notice shall be taken of such signature accordingly, without the necessity of proof of his appointment as Commissioner or Deputy Commissioner.
Address of Taxpayers.
46. For the purpose of any notice under the Act or Regulations, the address of any taxpayer or person, as described in any record of taxpayers in the custody of the Commissioner or the Deputy Commissioner, shall be deemed to be the usual or last known place of abode of such taxpayer or person.
Leasehold Estates.
47. In the case of land coming under Section 28 of the Act, the part of the unimproved value of the land corresponding to the unexpired term of the lease as mentioned in Section 28 (3a) of the Act shall be calculated under Table I. in the Schedule, upon the assumption that the annual unimproved value of the land is 4½ per cent. of the capital unimproved value.
Allowance on Account of Onerous Conditions.
48. For the purpose of an assessment under Section 28 (3b) of the Act of the amount (if any) which ought to be added to the value of the rent reserved under a lease on account of onerous conditions imposed upon the lessee for constructing buildings, works, or other improvements upon the land, or expending money thereon, table IV. in the Schedule shall be applied for the purpose of ascertaining the sinking fund required to replace the value of expenditure under onerous conditions as may be determined upon by the Commissioner.
Service of Notice.
49. Any notice served by or on behalf of the Commissioner by posting it to the usual or last known place of abode of any person shall be deemed to have been served at the time when it would, in the ordinary course of the post, have arrived at the place to which it was addressed, or to the post town or post-office nearest to that place, whether it has or has not been received by the addressee.
Signature or Authorized Officers.
50. A notice to be given by the Commissioner may be signed by any officer in the Department duly authorized in that behalf; and any notice purporting to be signed by authority of the Commissioner shall be as valid and effectual for all purposes as if signed by the Commissioner in person.
Liability for Unpaid Land Tax.
51. An inquiry by a purchaser to determine whether any liability for unpaid Land Tax attaches to any land purchased from a taxpayer may be made of the Deputy Commissioner of the State in which the land is situate. The inquiry shall be made in writing, and both the inquiry and copy of the reply furnished to the purchaser shall be filed for reference in the office to which the inquiry was directed.
Special Notices.
52. When the Commissioner, in the exercise of any power vested in him by the Act or Regulations, gives any special notice, such notice may prescribe the time within which the act therein mentioned may be done, being not less than seven days from the service of such notice.
Notices and Forms.
53. All notices and forms may be wholly or in part in writing or print or typewriting.
54. For the purposes of Sections 25, 28, and 34 of the Act the unimproved value of—
(a) land held by a legal tenant for life, without power to sell under a settlement made before 1st July, 1910, or under the will of a testator who died before that day;
(b) a leasehold estate in land made or agreed to be made before 17th November, 1910;
(c) an annuity charged on land under a settlement made before 1st July, 1910, or under the will of a testator who died before that day;
shall be calculated as follows :—
(i.) The value under (a) shall be the principal sum which, at 4½ per cent. per annum simple interest, would produce an annual sum equal to the rent which the tenant for life obtains for the land, or which, if he let the land, he ought reasonably to be able to obtain.
Provided that if the value thus obtained exceeds the actual unimproved value of the land, the actual unimproved value of the land shall be taken as the value under (a).
(ii.) The value under (b) shall be calculated on the basis of 4½ per cent. as follows:—
(a) where the lease is for a fixed period of years :—
Under Tables I. and V. in the Schedule in cases where the rent reserved by the lease varies during the currency of the lease; in all other cases, under Table I. in the Schedule.
(b) Where the lease is for a term of years, but determinable on the death of any person:—
In cases where the rent reserved by the lease varies during the currency of the lease, under—
(i.) Tables I. and V. in the Schedule; or
(ii.) Tables II. and V., or Tables III. and V., in the Schedule, as the case requires—
whichever gives the lower value.
In cases where the rent reserved by the lease does not vary during the currency of the lease, under—
(i.) Table I; or
(ii.) Table II. or Table III., as the case requires—
whichever gives the lower value.
(iii.) The value under (c) shall be calculated on the basis of 4½ per cent. under Table II. or III. in the Schedule hereto as the case requires.
Calculation of Sinking Funds.
55. In all cases in which it is necessary for purposes of an assessment to ascertain a Sinking Fund required to replace a sum of money during a number of years, Table IV. in the Schedule shall be applied.
56. These Regulations supersede the Provisional Regulations (Statutory Rules, 1911, Nos. 8, 23, 83, 103, 176, and 177).
<table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:18.4pt"><td style="width:27.52%; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:middle; background-color:#ffffff"><p class="Bodytext200" style="margin-left:11.35pt; text-indent:0pt; text-align:left; line-height:normal; font-size:11pt; background-color:transparent"><span style="font-family:'Times New Roman', serif">R</span><span class="Bodytext27pt" style="font-family:'Times New Roman', serif; font-size:11pt; letter-spacing:normal; vertical-align:baseline">eg. No</span></p></td><td rowspan="2" style="width:49.32%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p class="Bodytext200" style="text-indent:0pt; text-align:justify; line-height:normal; font-size:11pt; background-color:transparent"><img src="image.001.png" width="84" height="43" alt="" style="margin-right:9pt; margin-left:9pt; float:left; position:relative"><span class="Bodytext2CourierNew" style="font-family:'Times New Roman', serif; font-size:11pt; vertical-align:baseline">ill</span></p></td><td style="width:23.16%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:middle; background-color:#ffffff"><p class="Bodytext200" style="text-indent:0pt; line-height:normal; font-size:11pt; background-color:transparent"><span class="Bodytext265pt0" style="font-family:'Times New Roman', serif; font-size:11pt; letter-spacing:normal; vertical-align:baseline">Form A.</span></p></td></tr><tr style="height:12.65pt"><td rowspan="4" style="width:27.52%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p class="Bodytext200" style="margin-left:5.65pt; text-indent:8.5pt; text-align:justify; line-height:normal; font-size:11pt; background-color:transparent"><span class="Bodytext27pt" style="font-family:'Times New Roman', serif; font-size:11pt; letter-spacing:normal; vertical-align:baseline">This Return and all Correspondence relating thereto should be addressed to the Deputy Federal Commissioner of Land Tax,</span></p></td><td rowspan="4" style="width:23.16%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:middle; background-color:#ffffff"><p class="Bodytext200" style="margin-right:5.65pt; margin-left:5.65pt; text-indent:8.5pt; text-align:justify; line-height:normal; font-size:11pt; background-color:transparent"><span class="Bodytext27pt" style="font-family:'Times New Roman', serif; font-size:11pt; letter-spacing:normal; vertical-align:baseline">This form must not be used by taxpayers who own land in any other State than</span></p></td></tr><tr style="height:15.05pt"><td style="width:49.32%; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p class="Bodytext200" style="text-indent:0pt; line-height:normal; font-size:11pt; background-color:transparent"><span class="Bodytext265pt0" style="font-family:'Times New Roman', serif; font-size:11pt; letter-spacing:normal; vertical-align:baseline">Commonwealth of</span><span class="Bodytext265pt" style="font-family:'Times New Roman', serif; font-size:11pt; letter-spacing:normal; vertical-align:baseline"> </span><span class="Bodytext265pt0" style="font-family:'Times New Roman', serif; font-size:11pt; letter-spacing:normal; vertical-align:baseline">Australia.</span></p></td></tr><tr style="height:17.45pt"><td style="width:49.32%; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:bottom; background-color:#ffffff"><p class="Bodytext200" style="text-indent:0pt; line-height:normal; font-size:11pt; background-color:transparent"><span class="Bodytext27pt0" style="font-family:'Times New Roman', serif; font-size:11pt; letter-spacing:normal; vertical-align:baseline">Land Tax Assessment Act</span><span class="Bodytext27pt" style="font-family:'Times New Roman', serif; font-size:11pt; letter-spacing:normal; vertical-align:baseline"> 1910-1911.</span></p></td></tr><tr style="height:22pt"><td style="width:49.32%; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p class="Bodytext200" style="margin-left:36.85pt; text-indent:0pt; text-align:left; line-height:normal; font-size:11pt; background-color:transparent"><span class="Bodytext265pt0" style="font-family:'Times New Roman', serif; font-size:11pt; letter-spacing:normal; vertical-align:baseline">State of</span></p></td></tr></tbody></table>
__________
RETURN OF LAND OWNED JOINTLY OR SEVERALLY AS BENEFICIAL OWNER, TRUSTEE, OR LESSEE IN THE STATE OF BY—
If this return is made by an agent, trustee, public officer of company, or attorney, the name of the Principal should he placed here.
Name of Owner (Person or Company) in full
Occupation of Owner
Postal Address of Owner for service of notice
made in pursuance of the Land Tax Assessment Act 1910-1911 and the Regulations thereunder with respect to all land owned in one or more of the capacities stated above as at noon on the thirtieth day of June, 19 , according to the several particulars herein set forth, and of all deductions at such date as are allowed by law.
Land owned (particulars within) the unimproved value of which is....£
Less deductions allowed by law (particulars below)..............£
Taxable Balance..............................£
If the Owner is a shareholder in a Company owning land in Australia, state—
† “Original beneficiary” means:—“One of the persons specified in the settlement or will as entitled to the first life or greater interest thereunder in the land or the income therefrom, or to the first such interest in remainder after a life interest of the wife or husband of the settlor or testator.”
Declaration No. 1.—To be made by all Persons other than the Public Officer of a Company.
This declaration should be nude by resident owners and by agents for absentee owners.
I, the person making this return, do solemnly and sincerely declare that the return and the statements therein referred to or accompanying it contain full and accurate details of the several matters and things set forth, and in particular contain a full and accurate account of all land in the Commonwealth of Australia owned or administered by me in one or more of the capacities stated above as at noon on the thirtieth day of June, 19 .
And I further declare that the improved value stated therein against each parcel is the capital sum which the fee-simple of the land might be expected to realize if offered for sale on such reasonable terms and conditions as a bonâ fide seller would require, and the unimproved value stated therein against each parcel is the capital sum which the fee-simple of the land might be expected to realize if offered for sale on such reasonable terms and conditions as a bonâ fide seller would require assuming that the improvements thereon or appertaining thereto and made or acquired by the owner or his predecessor in title had not been made.
And I make this declaration under the provisions of the Land Tax Assessment Act 1910-1911.
Dated this day of 19
If this return is made by agent, trustee, or attorney his occupation and address to be inserted here.
Declaration No. 2.—To be made (in Addition to Declaration No. 1) by all Owners permanently residing in Australia.
This declaration should be made by all resident owners, but not by joint owners, trustees, or by agents for absentee owners.
I, the person making the foregoing return, do solemnly and sincerely further declare that I reside permanently in Australia or in a Territory under the authority of the Commonwealth.
And I make this declaration under the provisions of the Land Tax Assessment Act 1910-1911.
Dated this day of 19
(Usual Signature)
This Return is made—
In the capacity of†
________
Declaration No. 3.—To be made by the Public Officer of a Company in respect of Land owned by the Company.
I, being the duly appointed Public Officer of the above Company, and in that capacity duly authorized to make the foregoing return, do solemnly and sincerely declare that I am well acquainted with the affairs of the said Company, and that the said return and the statements therein referred to or accompanying such return contain full and accurate details of the several matters and things set forth, and in particular contain a full and accurate account of all lands in the Commonwealth of Australia owned by such Company in one or more of the capacities as stated above as at noon on the thirtieth day of June, 19 .
And I further declare that the improved value stated therein against each parcel is the capital sum which the fee-simple of the land might be expected to realize if offered for sale on such reasonable terms and conditions as a bonâ fide seller would require, and the unimproved value stated therein against each parcel is the capital sum which the fee-simple of the land might be expected to realize if offered for sale on such reasonable terms and conditions as a bonâ fide seller would require assuming that the improvements thereon or appertaining thereto and made or acquired by the owner or his predecessor in title had not been made.
And I make this declaration under the provisions of the Land Tax Assessment Act 1910-1911 and as such Public Officer as aforesaid.
* No Crown leases to be included, except perpetual leases without revaluation or leases with a right of purchase.
Particulars of Land—continued.
<table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:26.9pt"><td style="width:4.12%; border-top:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p class="Bodytext200" style="margin-right:11.35pt; margin-left:8.5pt; text-indent:-5.65pt; text-align:justify; line-height:normal; font-size:11pt; background-color:transparent"><span class="Bodytext265pt1" style="font-family:'Times New Roman', serif; font-size:11pt; letter-spacing:normal; vertical-align:baseline">Particulars of Improvements on or appertaining to Lands included in Returns to be stated here in all cases except Leasehold Land.</span></p></td><td colspan="8" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p class="Bodytext200" style="text-indent:0pt; line-height:normal; font-size:11pt; background-color:transparent"><span class="Bodytext265pt1" style="font-family:'Times New Roman', serif; font-size:11pt; letter-spacing:normal; vertical-align:baseline">Particulars </span><span class="Bodytext26pt" style="font-family:'Times New Roman', serif; font-size:11pt; letter-spacing:normal; vertical-align:baseline">re</span><span class="Bodytext265pt1" style="font-family:'Times New Roman', serif; font-size:11pt; letter-spacing:normal; vertical-align:baseline"> Land held under Legal Tenancy for Life, or subject to Annuity Charge.</span></p></td></tr><tr style="height:83.3pt"><td style="width:4.12%; height:83.3pt; writing-mode:tb-rl; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:83.3pt; writing-mode:tb-rl; overflow:hidden"><p class="Bodytext200" style="margin-right:5.65pt; margin-left:5.65pt; text-indent:0pt; text-align:justify; line-height:normal; font-size:11pt; background-color:transparent"><span class="Bodytext265pt1" style="font-family:'Times New Roman', serif; font-size:11pt; letter-spacing:normal; vertical-align:baseline">Consecutive No. 1st column on page 2</span></p></div></td><td style="width:15.7%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p class="Bodytext200" style="text-indent:0pt; line-height:normal; font-size:11pt; background-color:transparent"><span class="Bodytext265pt1" style="font-family:'Times New Roman', serif; font-size:11pt; letter-spacing:normal; vertical-align:baseline">Nature of Improvements.</span></p></td><td style="width:11.3%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p class="Bodytext200" style="text-indent:0pt; line-height:normal; font-size:11pt; background-color:transparent"><span class="Bodytext265pt1" style="font-family:'Times New Roman', serif; font-size:11pt; letter-spacing:normal; vertical-align:baseline">Value as at 30th June , </span><span class="Bodytext210pt" style="font-family:'Times New Roman', serif; font-size:11pt; vertical-align:baseline">19</span><span style="width:30.66pt; display:inline-block"> </span><span class="Bodytext210pt0" style="font-family:'Times New Roman', serif; font-size:11pt; letter-spacing:normal; vertical-align:baseline">.</span></p></td><td style="width:8.82%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p class="Bodytext200" style="text-indent:0pt; line-height:normal; font-size:11pt; background-color:transparent"><span class="Bodytext265pt1" style="font-family:'Times New Roman', serif; font-size:11pt; letter-spacing:normal; vertical-align:baseline">Full Name of Legal Life Tenant or</span><span style="font-family:'Times New Roman', serif; font-size:8.5pt"> </span><span class="Bodytext265pt1" style="font-family:'Times New Roman', serif; font-size:11pt; letter-spacing:normal; vertical-align:baseline">Annuitant.</span></p></td><td style="width:7.42%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p class="Bodytext200" style="text-indent:0pt; line-height:normal; font-size:11pt; background-color:transparent"><span class="Bodytext265pt1" style="font-family:'Times New Roman', serif; font-size:11pt; letter-spacing:normal; vertical-align:baseline">Date of Birth</span></p></td><td style="width:10.12%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p class="Bodytext200" style="text-indent:0pt; line-height:normal; font-size:11pt; background-color:transparent"><span class="Bodytext265pt1" style="font-family:'Times New Roman', serif; font-size:11pt; letter-spacing:normal; vertical-align:baseline">Amount of Annuity paid from Income from Land.</span></p></td><td style="width:8.76%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p class="Bodytext200" style="text-indent:0pt; line-height:normal; font-size:11pt; background-color:transparent"><span class="Bodytext265pt1" style="font-family:'Times New Roman', serif; font-size:11pt; letter-spacing:normal; vertical-align:baseline">Consecutive Nos. on Page 2 of Parcels charged with Annuity or held as Legal Life Tenant.</span></p></td><td style="width:8.08%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p class="Bodytext200" style="text-indent:0pt; line-height:normal; font-size:11pt; background-color:transparent"><span class="Bodytext265pt1" style="font-family:'Times New Roman', serif; font-size:11pt; letter-spacing:normal; vertical-align:baseline">Unimproved Value of the Land as at 30th June, </span><span class="Bodytext210pt" style="font-family:'Times New Roman', serif; font-size:11pt; vertical-align:baseline">19</span><span style="width:29.61pt; display:inline-block"> </span><span class="Bodytext210pt0" style="font-family:'Times New Roman', serif; font-size:11pt; letter-spacing:normal; vertical-align:baseline">.</span></p></td><td style="width:9.94%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p class="Bodytext200" style="text-indent:0pt; line-height:normal; font-size:11pt; background-color:transparent"><span class="Bodytext265pt1" style="font-family:'Times New Roman', serif; font-size:11pt; letter-spacing:normal; vertical-align:baseline">Date of Settlement creating Legal Tenancy for Life or Annuity. If under a Will, state Date of Testator’s Death.</span></p></td><td style="width:7.8%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p class="Bodytext200" style="text-indent:0pt; line-height:normal; font-size:11pt; background-color:transparent"><span class="Bodytext265pt1" style="font-family:'Times New Roman', serif; font-size:11pt; letter-spacing:normal; vertical-align:baseline">Total Amount of Annuity. Annual net Rental received by Legal Life Tenant, Gross Rental and Deductions to be shown.</span></p></td><td style="width:7.98%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p class="Bodytext200" style="text-indent:0pt; line-height:normal; font-size:11pt; background-color:transparent"><span class="Bodytext265pt1" style="font-family:'Times New Roman', serif; font-size:11pt; letter-spacing:normal; vertical-align:baseline">Has Life Tenant Power to Sell?</span></p></td></tr><tr style="height:27.1pt"><td style="width:4.12%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:15.7%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:11.3%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p class="Bodytext200" style="text-indent:0pt; line-height:normal; font-size:11pt; background-color:transparent"><span class="Bodytext265pt1" style="font-family:'Times New Roman', serif; font-size:11pt; letter-spacing:normal; vertical-align:baseline">£</span></p></td><td style="width:8.82%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:7.42%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:10.12%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p class="Bodytext200" style="text-indent:0pt; line-height:normal; font-size:11pt; background-color:transparent"><span class="Bodytext265pt1" style="font-family:'Times New Roman', serif; font-size:11pt; letter-spacing:normal; vertical-align:baseline">£</span></p></td><td style="width:8.76%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:8.08%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p class="Bodytext200" style="text-indent:0pt; line-height:normal; font-size:11pt; background-color:transparent"><span class="Bodytext265pt1" style="font-family:'Times New Roman', serif; font-size:11pt; letter-spacing:normal; vertical-align:baseline">£</span></p></td><td style="width:9.94%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:7.8%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p class="Bodytext200" style="text-indent:0pt; line-height:normal; font-size:11pt; background-color:transparent"><span class="Bodytext265pt1" style="font-family:'Times New Roman', serif; font-size:11pt; letter-spacing:normal; vertical-align:baseline">£</span></p></td><td style="width:7.98%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr></tbody></table>
<table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:22.8pt"><td colspan="13" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.12pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Foe Land Leased, fill in Particulars under the following Heads:—</span></p></td></tr><tr style="height:22.8pt"><td rowspan="4" style="width:7.92%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Consecutive No., 1st Column on</span><span style="font-family:'Times New Roman', serif"> </span><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Page 2.</span></p></td><td rowspan="4" style="width:4.34%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Date of Lease</span></p></td><td rowspan="4" style="width:3.96%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Term.</span></p></td><td rowspan="4" style="width:5.48%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Annual</span><span style="font-family:'Times New Roman', serif"> </span><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Rental</span><span style="font-family:'Times New Roman', serif"> </span><span style="font-family:'Times New Roman', serif; background-color:#ffffff">reserved</span><span style="font-family:'Times New Roman', serif"> </span><span style="font-family:'Times New Roman', serif; background-color:#ffffff">under</span><span style="font-family:'Times New Roman', serif"> </span><span style="font-family:'Times New Roman', serif; background-color:#ffffff">the Lease.</span></p></td><td rowspan="4" style="width:8.1%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">4½ per cent. of the Unimproved Value at 30th June, 19</span><span style="width:9.76pt; display:inline-block"> </span><span style="font-family:'Times New Roman', serif; background-color:#ffffff">.</span></p></td><td rowspan="4" style="width:17.1%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Amount to be expended by Lessee under Covenants for buildings or other improvements, or Amount of Fine, Premium, or Foregift payable by the Lessee to the Owner.</span></p><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Full details to be given.</span></p></td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Owner or Lessor, or Lessee.</span></p></td><td rowspan="4" style="width:12.12%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Nature of Improvements (if any) effected under Covenant, stating the materials of construction and date of erection.</span></p></td><td colspan="2" rowspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Freehold Values at Date of Lease.</span></p></td><td rowspan="2" style="width:8.5%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.12pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Freehold Value at 30th June, 19 .</span></p></td></tr><tr style="height:20.9pt"><td colspan="2" rowspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Name in Full.</span></p></td><td rowspan="3" style="width:5.8%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Address.</span></p></td></tr><tr style="height:20.9pt"><td rowspan="2" style="width:6.66%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Improved.</span></p></td><td rowspan="2" style="width:8.5%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Unimproved.</span></p></td><td rowspan="2" style="width:8.5%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.12pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Unimproved.</span></p></td></tr><tr style="height:22.3pt"><td style="width:5.72%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Owner or Lessor.</span></p></td><td style="width:5.8%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Lessee.</span></p></td></tr><tr style="height:61.7pt"><td style="width:7.92%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:4.34%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.96%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:5.48%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">£</span></p></td><td style="width:8.1%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">£</span></p></td><td style="width:17.1%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">£</span></p></td><td style="width:5.72%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:5.8%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:5.8%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:12.12%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:6.66%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">£</span></p></td><td style="width:8.5%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">£</span></p></td><td style="width:8.5%; border:0.75pt solid #000000; padding-right:0.12pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">£</span></p></td></tr><tr style="height:11.3pt"><td colspan="13" style="border-top:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:6pt; text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">If space in any column be insufficient to record particulars, a separate sheet, obtainable where the form of return was obtained, should be attached.</span></p></td></tr></tbody></table>
<table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:6.7pt"><td rowspan="2" style="width:11.84%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="margin-left:9pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">Reg. No.</span></p></td><td style="width:13.48%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:5%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:14.24%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:12.5%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:1.74%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.34%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:6.36%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:10.24%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:6.6%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:6.95pt"><td style="width:13.48%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:5%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:14.24%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td rowspan="3" style="width:12.5%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><img src="image.003.png" width="86" height="57" alt="Royal Coat of Arms of the United Kingdom"></p></td><td colspan="2" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:1.74%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.34%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:6.36%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td rowspan="2" style="width:10.24%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif; font-variant:small-caps; background-color:#ffffff">Form </span><span style="font-family:'Times New Roman', serif">B</span><span style="font-family:'Times New Roman', serif; font-style:italic; background-color:#ffffff">.</span></p></td><td style="width:6.6%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:6.7pt"><td colspan="2" rowspan="7" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="margin-right:7.2pt; margin-left:7.2pt; text-indent:21.6pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">This Return and all Correspondence relating thereto should be addressed to the Federal Commissioner of Land Tax, Melbourne.</span></p></td><td style="width:5%; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:14.24%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:1.74%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.34%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:6.36%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:6.6%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:8.15pt"><td style="width:5%; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:14.24%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:1.74%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.34%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:6.36%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:10.24%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:6.6%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:9.1pt"><td style="width:5%; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:14.24%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:12.5%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:1.74%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.34%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="3" rowspan="3" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="text-indent:21.6pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">To be used by Taxpayers who own land in more than one State.</span></p></td></tr><tr style="height:10.3pt"><td style="width:5%; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="4" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="font-size:11pt"><span style="font-family:'Times New Roman', serif">COMMONWEALTH OF AUSTRALIA</span></p></td><td style="width:1.74%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.34%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:12.95pt"><td style="width:5%; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:14.24%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:12.5%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:1.74%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.34%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:9.85pt"><td style="width:5%; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="5" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; font-style:italic; background-color:#ffffff">Land Tax Assessment Act</span><span style="font-family:'Times New Roman', serif"> 1910-1911.</span></p></td><td style="width:3.34%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:6.36%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:10.24%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:6.6%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:11.05pt"><td style="width:5%; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:14.24%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:12.5%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:10.94%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.34%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:6.36%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:10.24%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:6.6%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:0pt"><td style="width:62.15pt"></td><td style="width:70.7pt"></td><td style="width:26.2pt"></td><td style="width:74.7pt"></td><td style="width:65.55pt"></td><td style="width:57.35pt"></td><td style="width:19.5pt"></td><td style="width:9.15pt"></td><td style="width:17.5pt"></td><td style="width:33.35pt"></td><td style="width:53.7pt"></td><td style="width:34.6pt"></td></tr></tbody></table>
RETURN OF LAND OWNED JOINTLY OR SEVERALLY AS BENEFICIAL OWNER, TRUSTEE, OR LESSEE IN THE STATES OF BY—
If this return is made by an agent, trustee, public officer of company or attorney the name of the Principal should be placed here.
Name of Owner (Person or Company) in full
Occupation of Owner
Postal Address of Owner for service of notice
made in pursuance of the Land Tax Assessment Act 1910-1911 and the Regulations thereunder with respect to all land owned in one or more of the capacities stated above as at noon on the thirtieth day of June, 19 , according to the several particulars herein set forth, and of all deductions at such date as are allowed by law.
<table cellspacing="0" cellpadding="0" style="width:93.98%; margin-left:38.3pt; border-collapse:collapse"><tbody><tr style="height:6.7pt"><td colspan="2" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Land owned (particulars within) the unimproved value of which is</span><span style="width:77.36pt; font-family:'Lucida Console', monospace; background-color:#ffffff; display:inline-block">...........</span><span style="font-family:'Times New Roman', serif; background-color:#ffffff">£</span></p></td></tr><tr style="height:14.4pt"><td style="width:89.48%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Less deductions allowed by law (particulars below)</span><span style="width:143.05pt; font-family:'Lucida Console', monospace; background-color:#ffffff; display:inline-block">.....................</span><span style="font-family:'Times New Roman', serif; background-color:#ffffff">£</span></p></td><td style="width:10.52%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:12.7pt"><td style="width:89.48%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="margin-left:60.2pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Taxable Balance</span><span style="width:235.91pt; font-family:'Lucida Console', monospace; background-color:#ffffff; display:inline-block">...................................</span><span style="font-family:'Times New Roman', serif; background-color:#ffffff">£</span></p></td><td style="width:10.52%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr></tbody></table>
If the Owner is a shareholder in a Company owning land, state—
Name of Company
No. of Shares held at noon on 30th June. 19
Deductions Claimed From Unimproved Value.
<table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:21.35pt"><td rowspan="3" style="width:12.78%; border-top:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Statutory </span><span style="font-family:'Times New Roman', serif">D</span><span style="font-family:'Times New Roman', serif; background-color:#ffffff">eduction of £5,000.</span></p></td><td rowspan="3" style="width:14.38%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Unimproved Value of Lessee’s or Sub-Lessee’s Interest. Particulars, page 4.</span></p></td><td rowspan="3" style="width:14.84%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Unimproved</span><span style="font-family:'Times New Roman', serif"> </span><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Value</span><span style="font-family:'Times New Roman', serif"> </span><span style="font-family:'Times New Roman', serif; background-color:#ffffff">of</span><span style="font-family:'Times New Roman', serif"> </span><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Annuity Charge. Particulars, page 3.</span></p></td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Deductions under Section 38 (7) of the Act.</span></p></td><td rowspan="3" style="width:11.96%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Amount of Deduction Claimed.</span></p></td><td rowspan="3" style="width:11.96%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Total</span><span style="font-family:'Times New Roman', serif"> </span><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Deductions Claimed.</span></p></td></tr><tr style="height:25.9pt"><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">†Original Shares in the Land under the Will or Settlement.</span></p></td></tr><tr style="height:53.05pt"><td style="width:11.52%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Name of beneficiary and relationship to Settlor or Testator.</span></p></td><td style="width:11.82%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Address.</span></p></td><td style="width:10.76%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Share.</span></p></td></tr><tr style="height:43.7pt"><td style="width:12.78%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">£</span></p></td><td style="width:14.38%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">£</span></p></td><td style="width:14.84%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">£</span></p></td><td style="width:11.52%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:11.82%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:10.76%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:11.96%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">£</span></p></td><td style="width:11.96%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">£</span></p></td></tr></tbody></table>
* Insert name of owner.
† “Original beneficiary” means:—“One of the persons specified in the settlement or will as entitled to the first life or greater interest thereunder in the land or the income therefrom, or to the first such interest in remainder after a life interest of the wife or husband of the settlor or testator.”
Declaration No. 1.—To be Made by all Persons other than the Public Officer of a Company.
This declaration should fee made by resident owners and by agents for absentee owners.
I, the person making this return, do solemnly and sincerely declare that the return and the statements therein referred to or accompanying it contain full and accurate details of the several matters and things set forth, and in particular contain a full and accurate account of all land in the Commonwealth of Australia owned or administered by me in one or more of the capacities stated above as at noon on the thirtieth day of June, 19 .
And I further declare that the improved value stated therein against each parcel is the capital sum which the fee-simple of the land might be expected to realize if offered for sale on such reasonable terms and conditions as a bonâ fide seller would require, and the unimproved value stated therein against each parcel is the capital sum which the fee-simple of the land might be expected to realize if offered for sale on such reasonable terms and conditions as a bonâ fide seller would require assuming that the improvements thereon or appertaining thereto and made or acquired by the owner or his predecessor in title had not been made.
And I make this declaration under the provisions of the Land Tax Assessment Act 1910-1911.
Dated this day of 19
If this return is made by agent, trustee, or attorney his occupation and address to be inserted here.
Declaration No. 2.—To be made (in Addition to Declaration No. 1) by all Persons permanently residing in Australia.
This declaration should be made by all resident owners, but not by joint owners trustees or by the agent for an absentee owner.
I, the person making the foregoing return, do solemnly and sincerely further declare that I reside permanently in Australia or in a Territory under the authority of the Commonwealth.
And I make this declaration under the provisions of the Land Tax Assessment Act 1910-1911.
Dated this day of 19
<table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:9.1pt"><td style="width:23.54%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:4.26%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:13.82%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:19.14%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">(</span><span style="font-family:'Times New Roman', serif; font-style:italic; background-color:#ffffff">Usual Signature</span><span style="font-family:'Times New Roman', serif; background-color:#ffffff">)</span></p></td><td style="width:19.36%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.52%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:4.48%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:21.1pt"><td colspan="3" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">This Return is made—</span></p><p style="text-align:right; font-size:11pt"><span style="font-family:'Times New Roman', serif">In the capacity of*</span></p></td><td style="width:9.56%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:13.82%; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:19.14%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:19.36%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.52%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:4.48%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:0pt"><td style="width:123.4pt"></td><td style="width:22.35pt"></td><td style="width:12.15pt"></td><td style="width:50.15pt"></td><td style="width:72.5pt"></td><td style="width:100.4pt"></td><td style="width:101.55pt"></td><td style="width:18.45pt"></td><td style="width:23.5pt"></td></tr></tbody></table>
Declaration No. 3.-—To be made by the Public Officer of a Company in respect of Land owned by the Company.
I, being the duly appointed Public Officer of the above Company, and in that capacity duly authorized to make the foregoing return, do solemnly and sincerely declare that I am well acquainted with the affairs of the said Company, and that the said return and the statements therein referred to or accompanying such return contain full and accurate details of the several matters and things set forth, and in particular contain a full and accurate account of all lands in the Commonwealth of Australia owned by such Company in one or more of the capacities as stated above as at noon on the thirtieth day of June, 19 .
And I further declare that the improved value stated therein against each parcel is the capital sum which the fee-simple of the land might be expected to realize if offered for sale on such reasonable terms and conditions as a bonâ fide seller would require, and the- unimproved value stated therein against each parcel is the capital sum which the fee simple of the land might be expected to realize if offered for sale on such reasonable terms and conditions as a bonâ fide seller would require assuming that the improvements thereon or appertaining thereto and made or acquired by the owner or his predecessor in title had not been made.
<table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:17.5pt"><td colspan="7" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="margin-top:6pt; text-indent:21.6pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">And I make this declaration under the provisions of the </span><span style="font-family:'Times New Roman', serif; font-style:italic; background-color:#ffffff">Land Tax Assessment Act </span><span style="font-family:'Times New Roman', serif">1910-1911 and as such Public Officer as aforesaid.</span></p></td></tr><tr style="height:11.3pt"><td style="width:3.58%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:12.34%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="text-align:right; font-size:11pt"><span style="font-family:'Times New Roman', serif">Dated </span><span style="font-family:'Times New Roman', serif; background-color:#ffffff">this</span></p></td><td style="width:32.14%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:22.16%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">day of</span></p></td><td style="width:20.02%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.58%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">19</span></p></td><td style="width:6.18%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:19.45pt"><td style="width:3.58%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:12.34%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:32.14%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:12pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:22.16%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:right; font-size:11pt"><span style="font-family:'Times New Roman', serif">(</span><span style="font-family:'Times New Roman', serif; font-style:italic; background-color:#ffffff">Usual Signature</span><span style="font-family:'Times New Roman', serif; background-color:#ffffff">)</span></p></td><td style="width:20.02%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.58%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:6.18%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:13.45pt"><td colspan="7" style="border-top:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="margin-top:3pt; text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">* Fill in “Agent” “Trustee,” “Leaseholder,” “Beneficiary,” &c., as the case may be.</span></p></td></tr></tbody></table>
* No Crown leases to be included except perpetual leases without revaluation or leases with a right of purchase.
Particulars of Land—continued.
<table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:25.45pt"><td style="width:3.8%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="margin-left:21.6pt; text-indent:-21.6pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Particulars of Improvements on or appertaining to Lands included in Returns to be stated here in all cases except Leasehold Land.</span></p></td><td style="width:8.42%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="7" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Particulars re Land held under Legal Tenancy for Life, or subject to Annuity Charge.</span></p></td></tr><tr style="height:88.8pt"><td style="width:3.8%; height:88.8pt; margin-left:auto; writing-mode:tb-rl; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:88.8pt; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Consecutive No. 1st Column on Page 2.</span></p></div></td><td style="width:16.74%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Nature of Improvements.</span></p></td><td style="width:11.38%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Value as at 30th June, 19</span><span style="font-family:'Times New Roman', serif; background-color:#ffffff"> </span><span style="font-family:'Times New Roman', serif; background-color:#ffffff">.</span></p></td><td style="width:8.42%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Full Name of Legal Life Tenant or</span></p><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Annuitant.</span></p></td><td style="width:7.28%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Date of Birth</span></p></td><td style="width:9.62%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Amount of Annuity paid from Income from Land.</span></p></td><td style="width:9.24%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Consecutive Nos, on Page 2 of Parcels charged with Annuity or held as Legal Life Tenant.</span></p></td><td style="width:8.64%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Unimproved Value of the Land as-at 30th June,</span><br><span style="font-family:'Times New Roman', serif; background-color:#ffffff">19 </span><span style="font-family:'Times New Roman', serif; background-color:#ffffff"></span><span style="font-family:'Times New Roman', serif; background-color:#ffffff">.</span></p></td><td style="width:9.74%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Date of Settlement creating Legal Tenancy for Life or Annuity.</span></p><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">If under a Will, state Date of Testator’s Death.</span></p></td><td style="width:7.68%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Total Amount of Annuity. Annual net Rental received by Legal Life Tenant, Gross Rental and Deductions to be shown.</span></p></td><td style="width:7.5%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Has Life Tenant Power to Sell?</span></p></td></tr><tr style="height:29.05pt"><td style="width:3.8%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:16.74%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:11.38%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">£</span></p></td><td style="width:8.42%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:7.28%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:9.62%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">£</span></p></td><td style="width:9.24%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:8.64%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">£</span></p></td><td style="width:9.74%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:7.68%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">£</span></p></td><td style="width:7.5%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr></tbody></table>
<table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:20.9pt"><td colspan="13" style="border-top:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; font-variant:small-caps">For Land Leased, Fill In Particulars Under The Following Heads</span><span style="font-family:'Times New Roman', serif">:—</span></p></td></tr><tr style="height:20.9pt"><td rowspan="3" style="width:7.92%; border-top:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Consecutive No., </span><span style="font-family:'Times New Roman', serif; letter-spacing:-0.5pt; background-color:#ffffff">1</span><span style="font-family:'Times New Roman', serif; background-color:#ffffff">st Column on Page 2.</span></p></td><td rowspan="3" style="width:4.34%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Date of Lease.</span></p></td><td rowspan="3" style="width:3.96%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Term.</span></p></td><td rowspan="3" style="width:5.48%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Annual</span><span style="font-family:'Times New Roman', serif"> </span><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Rental</span><span style="font-family:'Times New Roman', serif"> </span><span style="font-family:'Times New Roman', serif; background-color:#ffffff">reserved</span><span style="font-family:'Times New Roman', serif"> </span><span style="font-family:'Times New Roman', serif; background-color:#ffffff">under</span><span style="font-family:'Times New Roman', serif"> </span><span style="font-family:'Times New Roman', serif; background-color:#ffffff">the</span><span style="font-family:'Times New Roman', serif"> </span><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Lease.</span></p></td><td rowspan="3" style="width:8.1%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">4½ per cent. of Unimproved Value at 30th June, 19</span><span style="font-family:'Times New Roman', serif; background-color:#ffffff"> </span><span style="font-family:'Times New Roman', serif; background-color:#ffffff"></span><span style="font-family:'Times New Roman', serif; background-color:#ffffff">.</span></p></td><td rowspan="3" style="width:17.04%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Amount to be expended by Lessee under Covenants for buildings or other improvements, or amount of Fine, Premium, or Foregift payable by the Lessee to the Owner.</span></p><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Full details to be given.</span></p></td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Owner or Lessor, or Lessee.</span></p></td><td rowspan="3" style="width:12.02%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Nature of Improvements (if any).</span></p></td><td colspan="2" rowspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Freehold Values at Date of Lease.</span></p></td><td rowspan="2" style="width:8.1%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Freehold Value at 30th June, 19</span><span style="font-family:'Times New Roman', serif; background-color:#ffffff"> </span><span style="font-family:'Times New Roman', serif; background-color:#ffffff"></span><span style="font-family:'Times New Roman', serif; background-color:#ffffff">.</span></p></td></tr><tr style="height:17.75pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Name in Full.</span></p></td><td rowspan="2" style="width:6.62%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Address.</span></p></td></tr><tr style="height:21.85pt"><td style="width:5.72%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Owner or Lessor.</span></p></td><td style="width:5.5%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Lessee.</span></p></td><td style="width:6.66%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Improved.</span></p></td><td style="width:8.5%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Unimproved.</span></p></td><td style="width:8.1%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Unimproved</span></p></td></tr><tr style="height:60.5pt"><td style="width:7.92%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:4.34%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.96%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:5.48%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">£</span></p></td><td style="width:8.1%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">£</span></p></td><td style="width:17.04%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:5.72%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:5.5%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:6.62%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:12.02%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:6.66%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">£</span></p></td><td style="width:8.5%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">£</span></p></td><td style="width:8.1%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">£</span></p></td></tr></tbody></table>
If space in any column be insufficient to record particulars, a separate sheet, obtainable where the form of return was obtained, should be attached.
<table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:14.9pt"><td style="width:9.72%; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">Reg. No.</span></p></td><td style="width:15.48%; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td rowspan="2" style="width:9.74%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="3" rowspan="2" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><img src="image.005.png" width="99" height="57" alt="Royal Coat of Arms of the United Kingdom"></p></td><td rowspan="2" style="width:10.12%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:2.34%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="3" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="margin-left:21.6pt; text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; font-variant:small-caps; background-color:#ffffff">Form</span><span style="font-family:'Times New Roman', serif"> C1.</span></p></td></tr><tr style="height:19.45pt"><td colspan="2" rowspan="4" style="border:0.75pt solid #000000; padding-right:0.12pt; padding-left:0.12pt; vertical-align:bottom; background-color:#ffffff"><p style="margin-right:7.2pt; margin-left:7.2pt; text-indent:21.6pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">This Return and all Correspondence relating thereto should be addressed to the Federal Commissioner of Land Tax, Melbourne.</span></p></td><td style="width:2.34%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="3" rowspan="2" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="text-indent:21.6pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">To be used by Taxpayers who own land in more than one State.</span></p></td></tr><tr style="height:18.25pt"><td colspan="5" style="border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; font-variant:small-caps; background-color:#ffffff">Commonwealth</span><span style="font-family:'Times New Roman', serif"> OF </span><span style="font-family:'Times New Roman', serif; font-variant:small-caps; background-color:#ffffff">Australia.</span></p></td><td style="width:2.34%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><div style="background-color:#ffffff"><p style="margin-left:15pt; text-indent:-15pt; line-height:7.7pt"><span style="font-family:'Times New Roman', serif; font-size:11pt"></span></p></div></td></tr><tr style="height:27pt"><td colspan="5" style="border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; font-style:italic; background-color:#ffffff">Land Tax Assessment Act</span><span style="font-family:'Times New Roman', serif"> 1910-1911</span></p></td><td rowspan="2" style="width:2.34%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><div style="background-color:#ffffff"><p style="margin-left:15pt; text-indent:-15pt; line-height:7.7pt"><span style="font-family:'Times New Roman', serif; font-size:11pt"></span></p></div></td><td rowspan="2" style="width:9%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td rowspan="2" style="width:9.16%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td rowspan="2" style="width:3.66%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:10.2pt"><td colspan="2" style="border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; font-weight:bold; font-style:italic"></span></p></td><td style="width:12.92%; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:0pt"><td style="width:44pt"></td><td style="width:70.05pt"></td><td style="width:44.05pt"></td><td style="width:44.95pt"></td><td style="width:58.45pt"></td><td style="width:35.85pt"></td><td style="width:45.8pt"></td><td style="width:10.6pt"></td><td style="width:40.7pt"></td><td style="width:41.45pt"></td><td style="width:16.55pt"></td></tr></tbody></table>
RETURN OF LAND OWNED JOINTLY OR SEVERALLY AS BENEFICIAL OWNER, TRUSTEE, OR LESSEE IN THE STATES OF BY—
If this return is made by an agent, trustee, public officer of company, or attorney, the name of the Principal should be placed here.
Name of Owner (Person or Company) in full
Occupation of Owner
Postal Address of Owner for service of notice
made in pursuance of the Land Tax Assessment Act 1910—1911 and the Regulations thereunder with respect to all land owned in one or more of the capacities stated above as at noon on the thirtieth day of June, 19 , according to the several particulars herein set forth, and of all deductions at such date as are allowed by law.
<table cellspacing="0" cellpadding="0" style="width:104.54%; border-collapse:collapse"><tbody><tr style="height:14.4pt"><td rowspan="2" style="width:86.02%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="margin-left:21.6pt; text-indent:-21.6pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">Land the unimproved value of which at noon on 30th June, 19 </span><span style="font-family:'Times New Roman', serif"></span><span style="font-family:'Times New Roman', serif">, was the same as that stated in return of land as owned at 30th June, 19 . </span><span style="font-family:'Times New Roman', serif"></span><span style="font-family:'Times New Roman', serif; background-color:#ffffff">£</span></p></td><td style="width:13.98%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:9.85pt"><td style="width:13.98%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:24pt"><td rowspan="2" style="width:86.02%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="margin-left:21.6pt; text-indent:-21.6pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">Land the unimproved value of which at noon on 30th June, 19 </span><span style="font-family:'Times New Roman', serif"></span><span style="font-family:'Times New Roman', serif">, was different from the value stated in return of land as owned at 30th June, 19</span><span style="font-family:'Times New Roman', serif"> </span><span style="font-family:'Times New Roman', serif"></span><span style="font-family:'Times New Roman', serif">(particulars and altered value as within)</span><span style="font-family:'Times New Roman', serif"> </span><span style="font-family:'Times New Roman', serif">£</span></p></td><td style="width:13.98%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:6.7pt"><td style="width:13.98%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:24pt"><td rowspan="2" style="width:86.02%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="margin-left:21.6pt; text-indent:-21.6pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">Land purchased or leased since noon on 30th June, 19</span><span style="font-family:'Times New Roman', serif"> </span><span style="font-family:'Times New Roman', serif"></span><span style="font-family:'Times New Roman', serif">, and owned or leased on 30th June, 19</span><span style="font-family:'Times New Roman', serif"> </span><span style="font-family:'Times New Roman', serif"></span><span style="font-family:'Times New Roman', serif">(particulars within), the unimproved value of which at noon on 30th June, 19</span><span style="font-family:'Times New Roman', serif"> </span><span style="font-family:'Times New Roman', serif"></span><span style="font-family:'Times New Roman', serif">, was</span><span style="font-family:'Times New Roman', serif"> </span><span style="font-family:'Times New Roman', serif">£</span></p></td><td style="width:13.98%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:9.1pt"><td style="width:13.98%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:8.9pt"><td style="width:86.02%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="width:399.5pt; font-family:'Lucida Console', monospace; display:inline-block">............................................................</span><span style="font-family:'Times New Roman', serif">£</span></p></td><td style="width:13.98%; border-top:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:24.95pt"><td rowspan="2" style="width:86.02%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="margin-left:21.6pt; text-indent:-21.6pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">Land held at noon on 30th June, 19</span><span style="font-family:'Times New Roman', serif"> </span><span style="font-family:'Times New Roman', serif"></span><span style="font-family:'Times New Roman', serif">, and sold between noon on 30th June, 19</span><span style="font-family:'Times New Roman', serif"> </span><span style="font-family:'Times New Roman', serif"></span><span style="font-family:'Times New Roman', serif">, and noon on 30th June, 19 </span><span style="font-family:'Times New Roman', serif"></span><span style="font-family:'Times New Roman', serif">(particulars within), the unimproved value of which as per such return was</span><span style="font-family:'Times New Roman', serif"> </span><span style="font-family:'Times New Roman', serif">£</span></p></td><td style="width:13.98%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:8.15pt"><td style="width:13.98%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:9.1pt"><td rowspan="2" style="width:86.02%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="margin-left:21.6pt; text-indent:0.9pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">Total Unimproved Value as at noon on 30th June, 19</span><span style="font-family:'Times New Roman', serif"> </span><span style="width:132.6pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">....................</span><span style="font-family:'Times New Roman', serif">£</span></p></td><td style="width:13.98%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:12.65pt"><td style="vertical-align:top"></td></tr><tr style="height:9.6pt"><td rowspan="2" style="width:86.02%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="margin-left:21.6pt; text-indent:0.9pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">Less Deductions allowed by law (particulars below)</span><span style="width:147.9pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">......................</span><span style="font-family:'Times New Roman', serif">£</span></p></td><td style="width:13.98%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:9.1pt"><td style="width:13.98%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:10.55pt"><td style="width:86.02%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="margin-left:21.6pt; text-indent:-8.1pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">Taxable Balance</span><span style="width:312.41pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">...............................................</span><span style="font-family:'Times New Roman', serif">£</span></p></td><td style="width:13.98%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:0pt"><td style="width:406.85pt"></td><td style="width:66.15pt"></td></tr></tbody></table>
If the Owner is a shareholder in a Company owning land, state—
Name of Company
No. of Shares held at noon on 30th June, 19
Deductions Claimed from Unimproved Value.
<table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:24pt"><td style="width:12.22%; border-top:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:14.58%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:14.5%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Deductions under Section 38(7) of the Act.</span></p></td><td style="width:12.74%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:12.06%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:25.45pt"><td rowspan="2" style="width:12.22%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Statutory Deduction of £5,000.</span></p></td><td rowspan="2" style="width:14.58%; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Unimproved Value of Lessee’s or Sub-Lessee’s Interest. Particulars, page 4.</span></p></td><td rowspan="2" style="width:14.5%; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Unimproved Value of Annuity Charge. Particulars, page 3.</span></p></td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">† Original Shares in the Land under the Will or Settlement.</span></p></td><td rowspan="2" style="width:12.74%; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Amount of Deduction Claimed.</span></p></td><td rowspan="2" style="width:12.06%; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Total</span><span style="font-family:'Times New Roman', serif"> </span><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Deductions Claimed.</span></p></td></tr><tr style="height:51.85pt"><td style="width:11.84%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Name of Beneficiary and relationship to Settlor or Testator.</span></p></td><td style="width:11.54%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Address.</span></p></td><td style="width:10.54%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Share.</span></p></td></tr><tr style="height:31.7pt"><td style="width:12.22%; border-top:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">£</span></p></td><td style="width:14.58%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">£</span></p></td><td style="width:14.5%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">£</span></p></td><td style="width:11.84%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:11.54%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:10.54%; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:12.74%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">£</span></p></td><td style="width:12.06%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">£</span></p></td></tr></tbody></table>
* Insert name of owner.
† “Original beneficiary” means:—“One of the persons specified in the settlement or will as entitled to the first life or greater interest thereunder in the land or the income therefrom, or to the first such interest in remainder after a life interest of the wife or husband of the settlor or testator.”
Declaration No. 1.—To be made by all Persons other than the Public Officer of a Company.
This declaration should he made, by resident owners and by agents for absentee owners.
I, the person making this return, do solemnly and sincerely declare that the return and the statements therein referred to or accompanying it contain full and accurate details of the several matters and things set forth, and in particular contain a full and accurate account of all land in the Commonwealth of Australia owned or administered by me in one or more of the capacities stated above as at noon on the thirtieth day of June, 19 .
And I further declare that the improved value stated therein against each parcel is the capital sum which the fee-simple of the land might be expected to realize if offered for sale on such reasonable terms and conditions as a bonâ fide seller would require, and the unimproved value stated therein against each parcel is the capital sum which the fee-simple of the land might be expected to realize if offered for sale on such reasonable terms and conditions as a bonâ fide seller would require assuming that the improvements thereon or appertaining thereto and made or acquired by the owner or his predecessor in title had not been made.
And I make this declaration under the provisions of the Land Tax Assessment Act 1910-1911.
Dated this
day of
19
If this return is made by agent, trustee, or attorney his occupation and address to be inserted here.
Declaration No. 2.—To be made (in Addition to Declaration No. 1) by all Owners permanently residing in Australia.
This declaration should be made by all resident owners, but not by joint owners, trustees, or by the agent for an absentee owner.
I, the person making the foregoing return, do solemnly and sincerely further declare that I reside permanently in Australia or in a Territory under the authority of the Commonwealth.
And I make this declaration under the provisions of the Land Tax Assessment Act 1910-1911.
Dated this day of 19
<table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:18.45pt"><td style="width:8.58%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:15.56%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:29.6%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:19.9%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">(</span><span style="font-family:'Times New Roman', serif; font-style:italic; background-color:#ffffff">Usual Signature</span><span style="font-family:'Times New Roman', serif; background-color:#ffffff">)</span></p></td><td style="width:18.28%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.92%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:4.16%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:21.6pt"><td colspan="3" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">This Return is made—</span></p><p style="margin-left:28.8pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">In the capacity of†</span></p></td><td style="width:19.9%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:18.28%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.92%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:4.16%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr></tbody></table>
Declaration No. 3.—To be made by the Public Officer of a Company in respect of Land owned by the Company.
I, being the duly appointed Public Officer of the above Company, and in that capacity duly authorized to make the foregoing return, do solemnly and sincerely declare that I am well acquainted with the affairs of the said Company, and that the said return and the statements therein referred to or accompanying such return contain full and accurate details of the several matters and things set forth, and in particular contain a full and accurate account of all lands in the Commonwealth of Australia owned by such Company in one or more of the capacities as stated above as at noon on the thirtieth day of June, 19 .
And I further declare that the improved value stated therein against each parcel is the capital sum which the fee-simple of the land might be expected to realize if offered for sale on such reasonable terms and conditions as a bonâ fide seller would require, and the unimproved value stated therein against each parcel is the capital sum which the fee-simple of the land might be expected to realize if offered for sale on such reasonable terms and conditions as a bonâ fide seller would require assuming that the improvements thereon or appertaining thereto and made or acquired by the owner or his predecessor in title had not been made.
And I make this declaration under the provisions of the Land Tax Assessment Act 1910-1911 and as such Public Officer as aforesaid.
Dated this
day of
19
(Usual Signature)
† Fill in Agent, “Trustee,” “Leaseholder,” “Beneficiary,” &c., as the case may be.
* No Crown leases to be included except perpetual leases without revaluation or leases with a right of purchase.
Particulars of Land—continued.
<table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:26.15pt"><td style="width:3.94%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:bottom; background-color:#ffffff"><p style="margin-left:14.4pt; text-indent:-14.4pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Particulars of Improvements on or appertaining to Lands shown on page 2 to be stated here in all cases except Leasehold Land.</span></p></td><td style="width:8.58%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="6" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Particulars re Land held under Legal Tenancy for Life, or</span><span style="font-family:'Times New Roman', serif"> </span><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Subject to Annuity Charge.</span></p></td><td style="width:7.44%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:83.3pt"><td style="width:3.94%; height:83.3pt; margin-left:auto; writing-mode:tb-rl; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:83.3pt; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Consecutive No, 1st Column on Page 2.</span></p></div></td><td style="width:15.68%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Nature of Improvements.</span></p></td><td style="width:11.06%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Value as at 30th June, 19</span><span style="width:33.41pt; display:inline-block"> </span><span style="font-family:'Times New Roman', serif; background-color:#ffffff">.</span></p></td><td style="width:8.58%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Full Name of Legal Life Tenant or</span><span style="font-family:'Times New Roman', serif"> </span><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Annuitant.</span></p></td><td style="width:7.36%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Date of Birth.</span></p></td><td style="width:9.68%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Amount of Annuity paid from Income from Land.</span></p></td><td style="width:9.1%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Consecutive Nos. on Page 2 of Parcels charged with Annuity or held as Legal Life Tenant.</span></p></td><td style="width:9.3%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Unimproved Value of the Land as at 30th June,</span><br><span style="font-family:'Times New Roman', serif; background-color:#ffffff">19</span><span style="width:25pt; display:inline-block"> </span><span style="font-family:'Times New Roman', serif; background-color:#ffffff">.</span></p></td><td style="width:9.48%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Date of Settlement creating Legal Tenancy for Life or Annuity.</span></p><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">If under a Will, state Date of Testator’s Death.</span></p></td><td style="width:8.38%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Total Amount of Annuity. Annual net Rental received by Legal Life Tenant, Gross Rental and Deductions to be shown.</span></p></td><td style="width:7.44%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Has Life Tenant Power to Sell?</span></p></td></tr><tr style="height:29.75pt"><td style="width:3.94%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:15.68%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:11.06%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">£</span></p></td><td style="width:8.58%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:7.36%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:9.68%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">£</span></p></td><td style="width:9.1%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:9.3%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">£</span></p></td><td style="width:9.48%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:8.38%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">£</span></p></td><td style="width:7.44%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr></tbody></table>
For Land Leased, fill in Particulars under the following Heads:—
<table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:17.5pt"><td rowspan="3" style="width:7.92%; border-top:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Consecutive No. 1st Column on Page 2.</span></p></td><td rowspan="3" style="width:4.2%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Date of Lease.</span></p></td><td rowspan="3" style="width:3.96%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Term.</span></p></td><td rowspan="3" style="width:5.48%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Annual Rental</span><span style="font-family:'Times New Roman', serif"> </span><span style="font-family:'Times New Roman', serif; background-color:#ffffff">reserved</span></p><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">under</span><span style="font-family:'Times New Roman', serif"> </span><span style="font-family:'Times New Roman', serif; background-color:#ffffff">the</span><span style="font-family:'Times New Roman', serif"> </span><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Lease.</span></p></td><td rowspan="3" style="width:8.1%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">4½ per cent. of the Unimproved Value at 30th June, 19 </span><span style="font-family:'Times New Roman', serif; background-color:#ffffff"></span><span style="font-family:'Times New Roman', serif; background-color:#ffffff">.</span></p></td><td rowspan="3" style="width:16.54%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Amount to be expended by Lessee under Covenants for buildings or other improvements, or Amount of Fine, Premium, or Foregift payable by the Lessee to the Owner. Full details to be given.</span></p></td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Owner or Lessor, or Lessee.</span></p></td><td rowspan="3" style="width:12.96%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Nature of Improvements (if any) effected under Covenant, stating the materials of construction and date of erection.</span></p></td><td colspan="2" rowspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Freehold Values at Date of Lease.</span></p></td><td rowspan="2" style="width:8.5%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Freehold Value at 30th June, 19</span><span style="width:3.48pt; display:inline-block"> </span><span style="font-family:'Times New Roman', serif; background-color:#ffffff">.</span></p></td></tr><tr style="height:18pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Name in Full.</span></p></td><td rowspan="2" style="width:8.68%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Address.</span></p></td></tr><tr style="height:28.3pt"><td style="width:4.74%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Owner or Lessor.</span></p></td><td style="width:5.48%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Lessee.</span></p></td><td style="width:4.9%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Improved.</span></p></td><td style="width:8.5%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Unimproved.</span></p></td><td style="width:8.5%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Unimproved.</span></p></td></tr><tr style="height:50.15pt"><td style="width:7.92%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:4.2%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.96%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:5.48%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">£</span></p></td><td style="width:8.1%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">£</span></p></td><td style="width:16.54%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">£</span></p></td><td style="width:4.74%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:5.48%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:8.68%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:12.96%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:4.9%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">£</span></p></td><td style="width:8.5%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">£</span></p></td><td style="width:8.5%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">£</span></p></td></tr></tbody></table>
If space in any column be insufficient to record particulars, a separate sheet, obtainable where the form of return was obtained, should be attached.
<table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:17.3pt"><td style="width:12.24%; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Reg. No.</span></p></td><td style="width:15.1%; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:2.18%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:15.32%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td rowspan="2" style="width:11.78%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><img src="image.005.png" width="99" height="57" alt="Royal Coat of Arms of the United Kingdom"></p></td><td style="width:16.08%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:4%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:23.32%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; background-color:#ffffff">Form </span><span style="font-family:'Times New Roman', serif">C2.</span></p></td></tr><tr style="height:12.7pt"><td colspan="2" rowspan="4" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="margin-right:7.2pt; margin-left:7.2pt; text-indent:7.2pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">This Return and all Correspondence relating thereto should be addressed to the Deputy Federal Commissioner of Land Tax,</span></p></td><td style="width:2.18%; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:15.32%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:16.08%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:4%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td rowspan="3" style="width:23.32%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="text-indent:7.2pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">This form should be used by taxpayers who own land only in the State of</span></p></td></tr><tr style="height:18.7pt"><td style="width:2.18%; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="3" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; font-variant:small-caps; background-color:#ffffff">Commonwealth of Australia.</span></p></td><td style="width:4%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:22pt"><td style="width:2.18%; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="3" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; font-style:italic; background-color:#ffffff">Land Tax Assessment Act</span><span style="font-family:'Times New Roman', serif"> 1910-1911</span></p></td><td style="width:4%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:18pt"><td style="width:2.18%; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:15.32%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:middle; background-color:#ffffff"><p style="margin-left:7.2pt; text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; font-variant:small-caps; background-color:#ffffff">State of</span></p></td><td style="width:11.78%; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:16.08%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:4%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:23.32%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr></tbody></table>
RETURN OF LAND OWNED JOINTLY OR SEVERALLY AS BENEFICIAL OWNER, TRUSTEE, OR LESSEE IN THE STATE OF
BY—
If this return is made by an agent, trustee, public officer of company, or attorney, the name of the Principal should be placed here.
Name of Owner (Person or Company) in full
Occupation of Owner
Postal Address of Owner for service of notice
made in pursuance of the Land Tax Assessment Act 1910-1911 and the Regulations thereunder with respect to all land owned in one or more of the capacities stated above as at noon on the thirtieth day of June, 19 , according to the several particulars herein set forth, and of all deductions at such date as are allowed by law.
<table cellspacing="0" cellpadding="0" style="width:98.44%; margin-left:31.65pt; border-collapse:collapse"><tbody><tr style="height:15.85pt"><td style="width:83.62%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="margin-left:14.4pt; text-indent:-14.4pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">Land the unimproved value of which at noon on 30th June, 19 </span><span style="font-family:'Times New Roman', serif"></span><span style="font-family:'Times New Roman', serif">, was the same as that stated in return of land as owned at 30th June, 19</span><span style="font-family:'Times New Roman', serif"> </span><span style="font-family:'Times New Roman', serif"></span><span style="font-family:'Times New Roman', serif">£</span></p></td><td colspan="2" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:23.3pt"><td colspan="2" rowspan="2" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="margin-left:14.4pt; text-indent:-14.4pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">Land the unimproved value of which at noon on 30th June, 19 </span><span style="font-family:'Times New Roman', serif"></span><span style="font-family:'Times New Roman', serif">, was different from the value stated in return of land as owned at 30th June, 19</span><span style="font-family:'Times New Roman', serif"> </span><span style="font-family:'Times New Roman', serif"></span><span style="font-family:'Times New Roman', serif">(particulars and altered value as within)</span><span style="font-family:'Times New Roman', serif"> </span><span style="font-family:'Times New Roman', serif">£</span></p></td><td style="width:16.1%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:8.15pt"><td style="width:16.1%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:23.3pt"><td colspan="2" rowspan="2" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="margin-left:14.4pt; text-indent:-14.4pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">Land purchased or leased since noon on 30th June, 19</span><span style="font-family:'Times New Roman', serif"> </span><span style="font-family:'Times New Roman', serif"></span><span style="font-family:'Times New Roman', serif">, and owned or leased on 30th June, 19 </span><span style="font-family:'Times New Roman', serif"></span><span style="font-family:'Times New Roman', serif">(particulars within), the unimproved value of which at noon on 30th June, 19</span><span style="font-family:'Times New Roman', serif"> </span><span style="font-family:'Times New Roman', serif"></span><span style="font-family:'Times New Roman', serif">, was</span><span style="font-family:'Times New Roman', serif"> </span><span style="font-family:'Times New Roman', serif">£</span></p></td><td style="width:16.1%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:9.85pt"><td style="width:16.1%; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:8.15pt"><td colspan="2" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:right; font-size:11pt"><span style="font-family:'Times New Roman', serif">£</span></p></td><td style="width:16.1%; border-top:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:24pt"><td colspan="2" rowspan="2" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="margin-left:14.4pt; text-indent:-14.4pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">Land held at noon on 30th June, 19</span><span style="font-family:'Times New Roman', serif"> </span><span style="font-family:'Times New Roman', serif"></span><span style="font-family:'Times New Roman', serif">, and sold between noon on 30th June, 19 </span><span style="font-family:'Times New Roman', serif"></span><span style="font-family:'Times New Roman', serif">, and noon on 30th June, 19 </span><span style="font-family:'Times New Roman', serif"></span><span style="font-family:'Times New Roman', serif">(particulars within), the unimproved value of which as per return of land as owned at 30th June, 19</span><span style="font-family:'Times New Roman', serif"> </span><span style="font-family:'Times New Roman', serif"></span><span style="font-family:'Times New Roman', serif">, was</span><span style="font-family:'Times New Roman', serif"> </span><span style="font-family:'Times New Roman', serif">£</span></p></td><td style="width:16.1%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:16.55pt"><td style="width:16.1%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:8.15pt"><td colspan="2" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="margin-left:26.35pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">Total Unimproved Value as at noon on 30th June, 19</span><span class="CommentReference"> </span><span style="font-family:'Times New Roman', serif"></span><span style="font-family:'Times New Roman', serif">,</span><span style="width:93.86pt; font-family:'Lucida Console', monospace; display:inline-block">..............</span><span style="font-family:'Times New Roman', serif">£</span></p></td><td style="width:16.1%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:8.15pt"><td colspan="2" rowspan="2" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="margin-left:26.35pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">Less Deductions allowed by law (particulars below)</span><span style="width:110.5pt; font-family:'Lucida Console', monospace; display:inline-block">................</span><span style="font-family:'Times New Roman', serif">£</span></p></td><td style="width:16.1%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:10.55pt"><td style="width:16.1%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:9.85pt"><td colspan="2" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="margin-left:53.35pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">Taxable Balance</span><span style="width:239.01pt; font-family:'Lucida Console', monospace; display:inline-block">....................................</span><span style="font-family:'Times New Roman', serif">£</span></p></td><td style="width:16.1%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:0pt"><td style="width:372.45pt"></td><td style="width:1.25pt"></td><td style="width:71.7pt"></td></tr></tbody></table>
If the Owner is a shareholder in a Company owning land state—
† “Original beneficiary” means:—“One of the persons specified in the settlement or will as entitled to the first life or greater interest thereunder in the land or the income therefrom, or to the first such interest in remainder after a life interest in the wife or husband of the settlor or testator.”
DECLARATION NO. 1.—TO BE MADE BY ALL PERSONS OTHER THAN THE PUBLIC OFFICER OF A COMPANY.
This declaration should be made by resident owners and by agents for absentee owners.
I, the person making this return, do solemnly and sincerely declare that the return and the statements therein referred to or accompanying it contain full and accurate details of the several matters and things set forth, and in particular contain a full and accurate account of all land in the Commonwealth of Australia owned or administered by me in one or more of the capacities stated above as at noon on the thirtieth day of June, 19
And I further declare that the improved value stated therein against each parcel is the capital sum which the fee-simple of the land might be expected to realize if offered, for sale on such reasonable terms and conditions as a bonâ fide seller would require, and the umimproved value stated therein against each parcel is the capital sum which the fee-simple of the land might be expected to realize if offered for sale on such reasonable terms and conditions as a bonâ fide seller would require assuming that the improvements thereon or appertaining thereto and made or acquired by the owner or his predecessor in title had not been made.
And I make this declaration under the provisions of the Land Tax Assessment Act 1910-1911.
Dated this day of 19
If this return is made by agent, trustee, or attorney, his occupation and address to be inserted here.
This declaration should be made by resident owners, but not by joint owners, trustees, or by the agent for an absentee owner.
I, the person making the foregoing return, do solemnly and sincerely further declare that I reside permanently in Australia or in a Territory under the authority of the Commonwealth.
And I make this declaration under the provisions of the Land Tax Assessment Act 1910-1911.
Dated this day of 19
(Usual Signature)
This Return is made—
In the capacity of†
Declaration No. 3.—To be made by the Public Officer of a Company in respect of Land owned by the Company.
I, being the duly appointed Public Officer of the above Company, and in that capacity duly authorized to make the foregoing return, do solemnly and sincerely declare that I am well acquainted with the affairs of the said Company, and that the said return and the statements therein referred to or accompanying such return contain full and accurate details of the several matters and things set forth, and in particular contain a full and accurate account of all lands in the Commonwealth of Australia owned by such Company in one or more of the capacities as stated above as at noon on the thirtieth day of June, 19
And I further declare that the improved value stated therein against each parcel is the capital sum which the fee-simple of the land might be expected to realize if offered for sale on such reasonable terms and conditions as a bonâ fide seller would require, and the unimproved value stated therein against each parcel is the capital sum which the fee-simple of the land might be expected to realize if offered for sale on such reasonable terms and conditions as a bonâ fide seller would require assuming that the improvements thereon or appertaining thereto and made or acquired by the owner or his predecessor in title had not been made.
And I make this declaration under the provisions of the Land Tax Assessment Act 1910-1911 and as such Public Officer as aforesaid.
* No Crown leases to be included except perpetual leases without revaluation or leases with a right of purchase.
<table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:11.7pt"><td colspan="11" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; font-variant:small-caps">Particulars of Land—</span><span style="font-family:'Times New Roman', serif; font-style:italic">continued.</span></p></td></tr><tr style="height:28pt"><td rowspan="2" style="width:4.22%; height:28pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:middle; background-color:#ffffff; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:28pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Consecutive No. 1st Column on Page 2.</span></p></div></td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="margin-left:14.4pt; text-indent:-14.4pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">Particulars of Improvements on or appertaining to Lauds shown on page 2 to be stated here in all cases except Leasehold Land.</span></p></td><td colspan="8" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Particulars re Land held under Legal Tenancy for Life, or subject to Annuity Charge.</span></p></td></tr><tr style="height:83.5pt"><td style="width:17.34%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Nature of Improvements.</span></p></td><td style="width:10.74%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Value as at 30th June, 19 </span><span style="font-family:'Times New Roman', serif"></span><span style="font-family:'Times New Roman', serif">.</span></p></td><td style="width:7.42%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Full Name of Legal Life Tenant or Annuitant.</span></p></td><td style="width:5.62%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Date of Birth.</span></p></td><td style="width:7.16%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Amount of Annuity paid from Income from Land.</span></p></td><td style="width:7.92%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Consecutive Nos. on Page 2 of Parcels charged with Annuity or held as Legal Life Tenant.</span></p></td><td style="width:8.1%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Unimproved Value of the Land as at 30th June, 19</span><span style="font-family:'Times New Roman', serif"> </span><span style="font-family:'Times New Roman', serif"></span><span style="font-family:'Times New Roman', serif">.</span></p></td><td style="width:7.8%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Date of Settlement creating Legal Tenancy for Life or Annuity.</span></p><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">If under a Will, state Date of Testator’s Death.</span></p></td><td style="width:10.9%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Total Amount of Annuity. Annual Net Rental received by Legal Life Tenant. Gross Rental and Deductions to be shown.</span></p></td><td style="width:12.76%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Has Life Tenant Power to Sell?</span></p></td></tr><tr style="height:31.1pt"><td style="width:4.22%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:17.34%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:10.74%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">£</span></p></td><td style="width:7.42%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:5.62%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:7.16%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">£</span></p></td><td style="width:7.92%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:8.1%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">£</span></p></td><td style="width:7.8%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:10.9%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">£</span></p></td><td style="width:12.76%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr></tbody></table>
<table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:26.8pt"><td colspan="13" style="border-top:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; font-variant:small-caps">For Land Leased, fill in Particulars under the following Heads:—</span></p></td></tr><tr style="height:26.3pt"><td rowspan="4" style="width:7.92%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Consecutive</span></p><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">No., 1st Column on Page 2.</span></p></td><td rowspan="4" style="width:4.2%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Date of Lease.</span></p></td><td rowspan="4" style="width:3.96%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Term.</span></p></td><td rowspan="4" style="width:5.48%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Annual Rental reserved under the Lease.</span></p></td><td rowspan="4" style="width:8.1%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">4½ per cent. of the Unimproved Value at 30th June, 19 </span><span style="font-family:'Times New Roman', serif"></span><span style="font-family:'Times New Roman', serif">.</span></p></td><td rowspan="4" style="width:14.54%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Amount to be expended by Lessee under Covenants for buildings or other improvements, or Amount of Fine, Premium, or Foregift payable by the Lessee to the Owner. Full details to be given.</span></p></td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Owner or Lessor, or Lessee.</span></p></td><td rowspan="4" style="width:12%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Nature of Improvements (if any) effected under Covenant, stating materials of construction and date of erection.</span></p></td><td colspan="2" rowspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Freehold Values at Date of Lease.</span></p></td><td rowspan="2" style="width:8.52%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Freehold Value at 30th June, 19 </span><span style="font-family:'Times New Roman', serif"></span><span style="font-family:'Times New Roman', serif">.</span></p></td></tr><tr style="height:20.9pt"><td colspan="2" rowspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Name in Full.</span></p></td><td rowspan="3" style="width:9.28%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Address.</span></p></td></tr><tr style="height:20.9pt"><td rowspan="2" style="width:6.66%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Improved.</span></p></td><td rowspan="2" style="width:8.52%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Unimproved.</span></p></td><td rowspan="2" style="width:8.52%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Unimproved.</span></p></td></tr><tr style="height:22.25pt"><td style="width:4.94%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Owner or Lessor.</span></p></td><td style="width:5.88%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Lessee.</span></p></td></tr><tr style="height:55pt"><td style="width:7.92%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:4.2%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.96%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:5.48%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">£</span></p></td><td style="width:8.1%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">£</span></p></td><td style="width:14.54%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">£</span></p></td><td style="width:4.94%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:5.88%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:9.28%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:12%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:6.66%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">£</span></p></td><td style="width:8.52%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">£</span></p></td><td style="width:8.52%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">£</span></p></td></tr><tr style="height:13.4pt"><td colspan="13" style="border-top:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">If space in any column be insufficient to record particulars, a separate sheet, obtainable where the form of return was obtained, should be attached.</span></p></td></tr></tbody></table>
Form D.
COMMONWEALTH OF AUSTRALIA.
NOTICE OF ALIENATION UNDER REGULATION 23.
Sir, 19 .
In accordance with Regulation 23, under the Land Tax Assessment Act 1910-11, I hereby notify you that I have sold the land described on the back hereof to the person, and on the terms there stated.
Yours faithfully,
The Commissioner of Land Tax,
<table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:9.1pt"><td colspan="21" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">[Back of Form D.]</span></p></td></tr><tr style="height:12pt"><td colspan="21" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; font-style:italic">Land Tax Assessment Act</span><span style="font-family:'Times New Roman', serif"> 1910-11.</span></p></td></tr><tr style="height:11.5pt"><td colspan="21" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; font-variant:small-caps">Notice of Alienation under Regulation 23.</span></p></td></tr><tr style="height:10.55pt"><td colspan="4" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">Name of Owner or Mortgagor</span></p></td><td colspan="6" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="margin-left:115.2pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">Reg. No</span></p></td><td colspan="6" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">Purchaser—</span></p></td><td style="width:1.34%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="4" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:9.6pt"><td colspan="4" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">Name of Mortgagee in possession</span></p></td><td colspan="6" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="margin-left:115.2pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">Reg. No</span></p></td><td colspan="6" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="margin-left:21.6pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">(</span><span style="font-family:'Times New Roman', serif; font-style:italic">Name in full</span><span style="font-family:'Times New Roman', serif">)</span></p></td><td style="width:1.34%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="4" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:8.9pt"><td colspan="4" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">Occupation</span></p></td><td colspan="6" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="6" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="margin-left:21.6pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">(</span><span style="font-family:'Times New Roman', serif; font-style:italic">Occupation</span><span style="font-family:'Times New Roman', serif">)</span></p></td><td style="width:1.34%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="4" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:6pt"><td colspan="4" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="6" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="6" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="margin-left:21.6pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">(</span><span style="font-family:'Times New Roman', serif; font-style:italic">Address</span><span style="font-family:'Times New Roman', serif">)</span></p></td><td style="width:1.34%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="4" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:14.9pt"><td colspan="4" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="12" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="margin-left:72pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif; font-variant:small-caps">Description of Land.</span></p></td><td style="width:1.34%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="4" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:26.4pt"><td rowspan="2" style="width:7.92%; border-top:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Consecutive No. on page 2 of Vendor’s last Return.</span></p></td><td colspan="2" rowspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">County, District, or Subdivision.</span></p></td><td colspan="2" rowspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Hundred, Parish, or Location.</span></p></td><td rowspan="2" style="width:7.64%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">No. of Section, Portion, Lot, &c.</span></p></td><td rowspan="2" style="width:8.68%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">City, Municipality, Town, Village, &c.</span></p></td><td colspan="2" rowspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Name of Street.</span></p></td><td rowspan="2" style="width:5.22%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Section or Sub- division No.</span></p></td><td rowspan="2" style="width:6.56%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Lot or Allotment No.</span></p></td><td colspan="2" rowspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Area of Country Land or Dimensions of City or Town Land.</span></p></td><td colspan="5" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Reference to Title.</span></p></td><td rowspan="2" style="width:5.56%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Date of Contract of Sale.</span></p></td><td rowspan="2" style="width:7.36%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Date when Purchaser obtained or will obtain Possession.</span></p></td><td rowspan="2" style="width:8.12%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Unimproved</span></p><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Value of the Land as per Vendor’s last return.</span></p></td></tr><tr style="height:56.7pt"><td style="width:2.04%; height:56.7pt; writing-mode:tb-rl; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:bottom; background-color:#ffffff; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:56.7pt; writing-mode:tb-rl; overflow:hidden"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">Book.</span></p></div></td><td style="width:2.04%; height:56.7pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:56.7pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="margin-right:5.65pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">No.</span></p></div></td><td colspan="2" style="height:56.7pt; writing-mode:tb-rl; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:bottom; background-color:#ffffff; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:56.7pt; writing-mode:tb-rl; overflow:hidden"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">Vol.</span></p></div></td><td style="width:2.04%; height:56.7pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:56.7pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="margin-right:5.65pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">Folio</span></p></div></td></tr><tr style="height:54.5pt"><td style="width:7.92%; border-top:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:2.28%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:7.14%; border-top:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:7.64%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:8.68%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:5.22%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:6.56%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:2.04%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:2.04%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:0.78%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:1.34%; border-top:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:2.04%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:5.56%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:7.36%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:8.12%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">£</span></p></td></tr><tr style="height:66.7pt"><td colspan="2" style="border-top:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Sale Price.</span></p></td><td colspan="2" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.12pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Amount Paid by Purchaser.</span></p></td><td style="width:7.14%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Accounts of succeeding Payments</span></p></td><td style="width:7.64%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Date of succeeding Payments.</span></p></td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Amount owing by Purchaser to Seller and secured by Mortgage or Charge on the Land.</span></p></td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Amount Lent to the Purchaser by the Seller and not secured by Mortgage or Charge on the Land.</span></p></td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Amount owing by the Purchaser to any other Person and directly or indirectly guaranteed by the Seller.</span></p></td><td colspan="9" rowspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-indent:21.6pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">I, the person making this return, do solemnly and sincerely declare that the return and the statements therein referred to contain full and accurate details of the several matters and things set forth, and that the above land has been sold by me in a </span><span style="font-family:'Times New Roman', serif; font-style:italic">bonâ fide</span><span style="font-family:'Times New Roman', serif"> manner and not for the purpose of evading payment of land tax.</span></p><p style="text-indent:21.6pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">And I make this declaration under the provisions of the </span><span style="font-family:'Times New Roman', serif; font-style:italic">Land Tax Assessment Act</span><span style="font-family:'Times New Roman', serif"> 1910-11.</span></p></td></tr><tr style="height:21.1pt"><td colspan="2" style="border-top:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">£</span></p></td><td colspan="2" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.12pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">£</span></p></td><td style="width:7.14%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">£</span></p></td><td style="width:7.64%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">£</span></p></td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">£</span></p></td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">£</span></p></td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">£</span></p></td></tr><tr style="height:8.15pt"><td colspan="2" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.12pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:7.14%; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:7.64%; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="5" style="border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">Dated this</span></p></td><td colspan="4" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:right; font-size:11pt"><span style="font-family:'Times New Roman', serif">day of</span></p></td></tr><tr style="height:10.55pt"><td colspan="2" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.12pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:7.14%; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:7.64%; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="5" style="border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="4" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="margin-left:28.8pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">19</span></p></td></tr><tr style="height:14.9pt"><td colspan="2" style="border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.12pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:7.14%; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:7.64%; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="9" style="border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif; font-style:italic">Usual Signature—</span></p></td></tr><tr style="height:0pt"><td style="width:55.4pt"></td><td style="width:8.9pt"></td><td style="width:69.25pt"></td><td style="width:16pt"></td><td style="width:49.9pt"></td><td style="width:53.35pt"></td><td style="width:60.6pt"></td><td style="width:8.65pt"></td><td style="width:35.75pt"></td><td style="width:36.45pt"></td><td style="width:45.85pt"></td><td style="width:28.65pt"></td><td style="width:25pt"></td><td style="width:14.3pt"></td><td style="width:14.3pt"></td><td style="width:5.6pt"></td><td style="width:9.35pt"></td><td style="width:14.3pt"></td><td style="width:38.9pt"></td><td style="width:51.45pt"></td><td style="width:56.75pt"></td></tr></tbody></table>
Form E.
COMMONWEALTH OF AUSTRALIA.
NOTICE OF PURCHASE UNDER REGULATION 23
Sir, 19
In accordance with Regulation 23, under the Land Tax Assessment Act 1910-11, I hereby notify you that I have purchased the land described on the back hereof from the person and on the terms there stated.
Yours faithfully,
The Commissioner of Land Tax,
[Back of Form E.]
Land Tax Assessment Act 1910-11.
Notice of Purchase under regulation 23.
<table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:8.9pt"><td colspan="6" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="9" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="10" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">Vendor—</span></p></td><td style="vertical-align:top"></td></tr><tr style="height:9.35pt"><td colspan="6" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">Name of Purchaser</span></p></td><td colspan="9" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Reg. No.</span></p></td><td colspan="10" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="margin-left:14.4pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">(</span><span style="font-family:'Times New Roman', serif; font-style:italic">Name in full</span><span style="font-family:'Times New Roman', serif">)</span></p></td><td style="vertical-align:top"></td></tr><tr style="height:9.6pt"><td colspan="6" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">Occupation</span></p></td><td colspan="9" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="10" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="margin-left:14.4pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">(</span><span style="font-family:'Times New Roman', serif; font-style:italic">Occupation</span><span style="font-family:'Times New Roman', serif">)</span></p></td><td style="vertical-align:top"></td></tr><tr style="height:16.3pt"><td colspan="6" style="border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">Address</span></p></td><td colspan="9" style="border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="margin-left:72pt; font-size:11pt"><span style="font-family:'Times New Roman', serif; font-variant:small-caps">Description of Land.</span></p></td><td colspan="10" style="border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="margin-left:14.4pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">(</span><span style="font-family:'Times New Roman', serif; font-style:italic">Address</span><span style="font-family:'Times New Roman', serif">)</span></p></td><td style="vertical-align:top"></td></tr><tr style="height:24pt"><td colspan="2" rowspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">County, District, or Subdivision.</span></p></td><td colspan="2" rowspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Hundred, Parish, or Location.</span></p></td><td colspan="3" rowspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">No. of Section, Portion, Lot, &c.</span></p></td><td colspan="2" rowspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">City, Municipality, Town, Village, &c.</span></p></td><td colspan="2" rowspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Name of Street.</span></p></td><td rowspan="2" style="width:7.7%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Section or Subdivision No.</span></p></td><td colspan="2" rowspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Lot or Allotment No.</span></p></td><td colspan="3" rowspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Area of Country Land or Dimensions of City or Town Land.</span></p></td><td colspan="5" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Reference to Title.</span></p></td><td rowspan="2" style="width:6.3%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Date of Contract of Sale.</span></p></td><td rowspan="2" style="width:7.52%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Date when Purchaser obtained or will obtain Possession.</span></p></td><td rowspan="2" style="width:8.94%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.12pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Unimproved Value of the Land as at date of sale.</span></p></td><td style="vertical-align:top"></td></tr><tr style="height:56.7pt"><td style="width:2.2%; height:56.7pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:56.7pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="margin-right:5.65pt; margin-left:5.65pt; font-size:11pt"><span style="font-family:'Times New Roman', serif">Book</span></p></div></td><td style="width:2.62%; height:56.7pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:56.7pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="margin-right:5.65pt; margin-left:5.65pt; font-size:11pt"><span style="font-family:'Times New Roman', serif">No</span></p></div></td><td style="width:2.58%; height:56.7pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:56.7pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="margin-right:5.65pt; margin-left:5.65pt; font-size:11pt"><span style="font-family:'Times New Roman', serif">Vol.</span></p></div></td><td colspan="2" style="height:56.7pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:56.7pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="margin-right:5.65pt; margin-left:5.65pt; font-size:11pt"><span style="font-family:'Times New Roman', serif">Folio</span></p></div></td><td style="vertical-align:top"></td></tr><tr style="height:52.3pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:7.7%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:2.2%; height:52.3pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:52.3pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></div></td><td style="width:2.62%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:2.58%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:6.3%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:7.52%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:8.94%; border:0.75pt solid #000000; padding-right:0.12pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">£</span></p></td><td style="border-bottom:0.75pt solid #000000; vertical-align:top"></td></tr><tr style="height:63.85pt"><td style="width:8.18%; border-top:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Sale Price.</span></p></td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Amount Paid by Purchaser.</span></p></td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Amounts of succeeding Payments.</span></p></td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Dates of succeeding Payments.</span></p></td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Amount owing by Purchaser to Seller and secured by Mortgage or Charge on the Land.</span></p></td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Amount Lent to the Purchaser by the Seller and not secured by Mortgage or Charge on the Land.</span></p></td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Amount owing by the Purchaser to any other Person and directly or indirectly guaranteed by the Seller.</span></p></td><td colspan="10" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:bottom; background-color:#ffffff"><p style="text-indent:14.4pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">I, the person making this return, do solemnly and sincerely declare that the return and the statements therein referred to contain full and accurate details of the several matters and things set forth, and that the above land has been bought by me in a </span><span style="font-family:'Times New Roman', serif; font-style:italic">bonâ fide</span><span style="font-family:'Times New Roman', serif"> manner and not for the purpose of evading payment of land tax.</span></p></td></tr><tr style="height:28.75pt"><td style="width:8.18%; border-top:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">£</span></p></td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">£</span></p></td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">£</span></p></td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">£</span></p></td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">£</span></p></td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">£</span></p></td><td colspan="10" style="border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-indent:14.4pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">And I make this declaration under the provisions of the </span><span style="font-family:'Times New Roman', serif; font-style:italic">Land Tax Assessment Act</span><span style="font-family:'Times New Roman', serif"> 1910-11.</span></p></td></tr><tr style="height:11.3pt"><td style="width:8.18%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="3" style="border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="3" style="border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="3" style="border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="5" style="border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:bottom; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">Dated this</span></p></td><td colspan="5" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="text-align:right; font-size:11pt"><span style="font-family:'Times New Roman', serif">day of</span></p></td></tr><tr style="height:9.6pt"><td style="width:8.18%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="3" style="border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="3" style="border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="3" style="border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="5" style="border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="5" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">19</span></p></td></tr><tr style="height:13.7pt"><td style="width:8.18%; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="3" style="border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="3" style="border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="3" style="border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="10" style="border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif; font-style:italic">Usual Signature</span><span style="font-family:'Times New Roman', serif">—</span></p></td></tr><tr style="height:0pt"><td style="width:56.6pt"></td><td style="width:51.3pt"></td><td style="width:8.25pt"></td><td style="width:42.5pt"></td><td style="width:17.05pt"></td><td style="width:8.4pt"></td><td style="width:24.05pt"></td><td style="width:30.2pt"></td><td style="width:30.4pt"></td><td style="width:32.75pt"></td><td style="width:17.2pt"></td><td style="width:53.65pt"></td><td style="width:18.5pt"></td><td style="width:27.15pt"></td><td style="width:19.85pt"></td><td style="width:29.3pt"></td><td style="width:4.45pt"></td><td style="width:14.35pt"></td><td style="width:17.4pt"></td><td style="width:17.55pt"></td><td style="width:13.05pt"></td><td style="width:2.75pt"></td><td style="width:43.45pt"></td><td style="width:52.05pt"></td><td style="width:61.95pt"></td><td style="width:4.55pt"></td></tr></tbody></table>
<table cellspacing="0" cellpadding="0" style="width:100.28%; border-collapse:collapse"><tbody><tr style="height:11.25pt"><td colspan="5" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">Register No.</span></p></td><td colspan="2" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="3" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="17" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; font-style:italic">Land Tax Assessment Act</span><span style="font-family:'Times New Roman', serif"> 1910.</span></p></td><td style="width:3.58%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:2.58%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:5.04%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif; font-variant:small-caps">Form F.</span></p></td></tr><tr style="height:18.2pt"><td colspan="5" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="20" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">NOTICE OF ALIENATION UNDER REGULATION 23 BY (Name of Company)</span></p></td><td style="width:3.58%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:2.58%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:5.04%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:19.15pt"><td colspan="5" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="3" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="17" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">SCHEDULE OF LANDS DISPOSED OF.</span></p></td><td style="width:3.58%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:2.58%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:5.04%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:62.9pt"><td colspan="2" rowspan="2" style="height:62.9pt; margin-left:auto; writing-mode:tb-rl; border-top:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:62.9pt; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="font-size:10pt"><span style="font-family:'Times New Roman', serif">Consecutive .No on Page 2 of Vendor’s last Return.</span></p></div></td><td rowspan="2" style="width:5.78%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:10pt"><span style="font-family:'Times New Roman', serif">County, District or Subdivision.</span></p></td><td colspan="2" rowspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:10pt"><span style="font-family:'Times New Roman', serif">Hundred, Parish, or Location.</span></p></td><td colspan="2" rowspan="2" style="height:62.9pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:62.9pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="font-size:10pt"><span style="font-family:'Times New Roman', serif">City Municipality, Town, Village, &c.</span></p></div></td><td rowspan="2" style="width:2.34%; height:62.9pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:62.9pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="font-size:10pt"><span style="font-family:'Times New Roman', serif">Name of Street.</span></p></div></td><td rowspan="2" style="width:3.64%; height:62.9pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:62.9pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="font-size:10pt"><span style="font-family:'Times New Roman', serif">No. of Section, Portion, Lot, &c.</span></p></div></td><td rowspan="2" style="width:2.04%; height:62.9pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:62.9pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="font-size:10pt"><span style="font-family:'Times New Roman', serif">Sec. or Subdivision No.</span></p></div></td><td rowspan="2" style="width:2.04%; height:62.9pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:62.9pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="font-size:10pt"><span style="font-family:'Times New Roman', serif">Lot or Allotment No.</span></p></div></td><td rowspan="2" style="width:7.66%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:10pt"><span style="font-family:'Times New Roman', serif">Area of Country Land or Dimensions of City or Town Land.</span></p></td><td colspan="4" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:10pt"><span style="font-family:'Times New Roman', serif">Reference To Title.</span></p></td><td rowspan="2" style="width:3.64%; height:62.9pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; border:0.75pt solid #000000; padding-right:0.12pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:62.9pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="font-size:10pt"><span style="font-family:'Times New Roman', serif">Date of Contract of Sale.</span></p></div></td><td colspan="2" rowspan="2" style="height:62.9pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:62.9pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="font-size:10pt"><span style="font-family:'Times New Roman', serif">Date when Purchaser obtained or will obtain possession.</span></p></div></td><td colspan="4" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:10pt"><span style="font-family:'Times New Roman', serif">Purchaser.</span></p></td><td colspan="2" rowspan="2" style="height:62.9pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:62.9pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="font-size:10pt"><span style="font-family:'Times New Roman', serif">Unimproved Value of the Land as per Vendor’s last return.</span></p></div></td><td rowspan="2" style="width:2.82%; height:62.9pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:62.9pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="font-size:10pt"><span style="font-family:'Times New Roman', serif">Sale Price.</span></p></div></td><td rowspan="2" style="width:3.58%; height:62.9pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:62.9pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="font-size:10pt"><span style="font-family:'Times New Roman', serif">Amount Paid by Purchaser.</span></p></div></td><td rowspan="2" style="width:3.58%; height:62.9pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:62.9pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="font-size:10pt"><span style="font-family:'Times New Roman', serif">Amounts of Succeeding Payments.</span></p></div></td><td rowspan="2" style="width:2.58%; height:62.9pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:62.9pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="font-size:10pt"><span style="font-family:'Times New Roman', serif">Dates of Succeeding Payments.</span></p></div></td><td rowspan="2" style="width:5.04%; height:62.9pt; margin-left:auto; writing-mode:tb-rl; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:62.9pt; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="font-size:10pt"><span style="font-family:'Times New Roman', serif">Amount Owing by Purchaser to Seller, and secured by mortgage or charge on the land.</span></p></div></td><td rowspan="2" style="width:4.8%; height:62.9pt; margin-left:auto; writing-mode:tb-rl; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:62.9pt; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="font-size:10pt"><span style="font-family:'Times New Roman', serif">Amount Lent to the Purchaser by the Seller, and not secured by mortgage or charge on the land.</span></p></div></td><td rowspan="2" style="width:4.94%; height:62.9pt; margin-left:auto; writing-mode:tb-rl; border:0.75pt solid #000000; padding-right:0.12pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:62.9pt; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="font-size:10pt"><span style="font-family:'Times New Roman', serif">Amount Owing by the Purchaser to any other person and directly or indirectly</span><span style="font-family:'Times New Roman', serif"> </span><span style="font-family:'Times New Roman', serif">guaranteed by the Seller.</span></p></div></td></tr><tr style="height:89.05pt"><td style="width:1.68%; height:89.05pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; border:0.75pt solid #000000; padding-right:0.12pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:89.05pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="margin-right:5.65pt; margin-left:5.65pt; font-size:11pt"><span style="font-family:'Times New Roman', serif">Book</span></p></div></td><td style="width:1.6%; height:89.05pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:89.05pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="margin-right:5.65pt; margin-left:5.65pt; font-size:11pt"><span style="font-family:'Times New Roman', serif">No.</span></p></div></td><td style="width:1.64%; height:89.05pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:89.05pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="margin-right:5.65pt; margin-left:5.65pt; font-size:11pt"><span style="font-family:'Times New Roman', serif">Vol.</span></p></div></td><td style="width:1.6%; height:89.05pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:89.05pt; margin-right:auto; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="margin-right:5.65pt; margin-left:5.65pt; font-size:11pt"><span style="font-family:'Times New Roman', serif">Folio.</span></p></div></td><td style="width:5.08%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Name in Full.</span></p></td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Occupation.</span></p></td><td style="width:5.32%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">Address</span></p></td></tr><tr style="height:102.6pt"><td colspan="2" style="border-top:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:5.78%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:2.34%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.64%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:2.04%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:2.04%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:7.66%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:1.68%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:1.6%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:1.64%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:1.6%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.64%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:5.08%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:5.32%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">£</span></p></td><td style="width:2.82%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">£</span></p></td><td style="width:3.58%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">£</span></p></td><td style="width:3.58%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">£</span></p></td><td style="width:2.58%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:5.04%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">£</span></p><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:4.8%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">£</span></p></td><td style="width:4.94%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">£</span></p></td></tr><tr style="height:87.35pt"><td colspan="32" style="border-top:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="margin-bottom:12pt; text-indent:14.4pt; font-size:11pt"><span style="font-family:'Times New Roman', serif">I, the person making this return, do solemnly and sincerely declare that the return and the statements therein referred to contain full and accurate details of the several matters and things set forth, and that the above land has been sold by </span><span style="font-family:'Times New Roman', serif"></span><span style="font-family:'Times New Roman', serif"></span><span style="font-family:'Times New Roman', serif">in a </span><span style="font-family:'Times New Roman', serif; font-style:italic">bonâ fide</span><span style="font-family:'Times New Roman', serif"> manner, and not for the purpose or evading payment of Land Tax, And 1 make this declaration under the provisions of the </span><span style="font-family:'Times New Roman', serif; font-style:italic">Land Tax Assessment Act</span><span style="font-family:'Times New Roman', serif"> 1910-11.</span></p></td></tr><tr style="height:10.5pt"><td style="width:2.52%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="3" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="3" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">Dated this</span></p></td><td style="width:2.34%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="3" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:right; font-size:11pt"><span style="font-family:'Times New Roman', serif">day of</span></p></td><td style="width:7.66%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:1.68%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">19</span></p></td><td style="width:1.6%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.64%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.52%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="3" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:5.32%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:5.32%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.42%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.58%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.58%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:2.58%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:5.04%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:4.8%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:4.94%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:13.15pt"><td style="width:2.52%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="3" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.58%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:2.34%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.64%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:2.04%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:2.04%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:7.66%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:1.68%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:1.6%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:1.64%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:1.6%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.64%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.52%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="5" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">(</span><span style="font-family:'Times New Roman', serif; font-style:italic">Usual Signature</span><span style="font-family:'Times New Roman', serif">)</span><span style="font-family:'Times New Roman', serif; font-size:7.33pt; vertical-align:sub">(</span></p></td><td style="width:3.42%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.58%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.58%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:2.58%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:5.04%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:4.8%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:4.94%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:0pt"><td style="width:17.7pt"></td><td style="width:9.85pt"></td><td style="width:40.5pt"></td><td style="width:6.05pt"></td><td style="width:39.1pt"></td><td style="width:3.8pt"></td><td style="width:25.2pt"></td><td style="width:16.4pt"></td><td style="width:25.5pt"></td><td style="width:14.3pt"></td><td style="width:14.3pt"></td><td style="width:53.65pt"></td><td style="width:11.75pt"></td><td style="width:11.2pt"></td><td style="width:11.5pt"></td><td style="width:11.2pt"></td><td style="width:25.5pt"></td><td style="width:24.65pt"></td><td style="width:3.5pt"></td><td style="width:35.6pt"></td><td style="width:4.2pt"></td><td style="width:37.25pt"></td><td style="width:37.25pt"></td><td style="width:23.95pt"></td><td style="width:5.3pt"></td><td style="width:19.75pt"></td><td style="width:25.1pt"></td><td style="width:25.1pt"></td><td style="width:18.1pt"></td><td style="width:35.3pt"></td><td style="width:33.65pt"></td><td style="width:34.45pt"></td></tr></tbody></table>
Form G
Land Tax Assessment Act 1910-11.
NOTICE OF ACQUISITION OF LAND BY LEASE.
Regulation 25.
Name of Lessee
Reg. No.
Name of Lessor
Occupation
Occupation
Address
Address
Description of Land Leased.
County
Parish.
City, Municipality, Town, Village, &c.
Name of Street.
Section
Allotment
Area of Country Lands and Dimensions of City or Town Lands.
Reg. No. of Lease.
Date of Lease.
Period of Lease.
Is Lease an Original or a Sub-lease?
If a Sub-lease state Name and Address of Mesne Lessee.
<table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:27.35pt"><td colspan="5" style="border-top:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="margin-left:28.8pt; text-indent:-28.8pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">If the Land leased comes under any of the headings printed on the back hereof, fill in the columns below.</span></p></td><td rowspan="4" style="width:35.12%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-indent:21.6pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">I, the person making this return, do solemnly and sincerely declare that the return and the statements therein referred to contain full and accurate details of the several matters and things set forth.</span></p><p style="text-indent:14.4pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">And I make this declaration under the provisions of the </span><span style="font-family:'Times New Roman', serif; font-style:italic">Land Tax Assessment Act </span><span style="font-family:'Times New Roman', serif">1910-11.</span></p></td></tr><tr style="height:38.65pt"><td rowspan="2" style="width:11.58%; border-top:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:10pt"><span style="font-family:'Times New Roman', serif">Heading under which Land comes.</span></p></td><td rowspan="2" style="width:8.96%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:10pt"><span style="font-family:'Times New Roman', serif">Rent Reserved under Lease.</span></p></td><td rowspan="2" style="width:19.8%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:10pt"><span style="font-family:'Times New Roman', serif">Amount to be expended by Lessee under Covenants for buildings or other improvements, or Amount of Fine, Premium, or Foregift payable by the Lessee to the Owner. Full details to be given.</span></p></td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:10pt"><span style="font-family:'Times New Roman', serif">Freehold Values at Date of Lease.</span></p></td></tr><tr style="height:31.7pt"><td style="width:11.14%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:10pt"><span style="font-family:'Times New Roman', serif">Improved.</span></p></td><td style="width:13.38%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:10pt"><span style="font-family:'Times New Roman', serif">Unimproved.</span></p></td></tr><tr style="height:11.3pt"><td style="width:11.58%; border-top:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:8.96%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:19.8%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:11.14%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:10pt"><span style="font-family:'Times New Roman', serif">£</span></p></td><td style="width:13.38%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:10pt"><span style="font-family:'Times New Roman', serif">£</span></p></td></tr><tr style="height:12.95pt"><td style="width:11.58%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:8.96%; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:19.8%; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:11.14%; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:13.38%; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:35.12%; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">Dated this </span><span style="width:63.54pt; display:inline-block"></span><span style="font-family:'Times New Roman', serif">day of</span></p></td></tr><tr style="height:18pt"><td style="width:11.58%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:8.96%; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:19.8%; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:11.14%; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:13.38%; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:35.12%; border-left:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">191</span></p></td></tr><tr style="height:10.8pt"><td style="width:11.58%; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:8.96%; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:19.8%; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:11.14%; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:13.38%; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:0.5pt; padding-left:0.12pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:35.12%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; font-style:italic">Usual Signature</span></p></td></tr></tbody></table>
[Back of Form.]
Sec. 13.—The following lands shall be exempt from taxation under this Act, namely:‑‑‑‑‑
(a) all land owned by a State, or by a municipal, local, or other public authority of a State;
(b) all land owned by a Savings Bank regulated by any State Act;
(c) all land owned by any society registered under a State Act relating to friendly societies or trade unions;
(d) all land owned by any building society registered as a building society under any Act or State Act, not being land of which the society has become owner by foreclosure of a mortgage;
(e) all land owned by or in trust for a charitable or educational institution, if the institution, however formed or constituted, is carried on solely for charitable or educational purposes and not for pecuniary profit;
(f) all land owned by or in trust for a religious society, the proceeds whereof are devoted solely to the support of the aged or infirm clergy or ministers of the society or their wives or widows or children, or to religious, charitable, or educational purposes ;
(g) all land owned by or in trust for any person or society, and used or occupied by that person or society solely as a site for—
(1)
a
place of worship for a religious society, or a place of residence for any clergy or ministers, or order of a religious society;
(2)
a
charitable or educational institution not carried on for pecuniary profit;
(3)
a
building owned and occupied by a society, club, or association not carried on for pecuniary profit;
(4)
a
public library, institute, or museum;
(5)
a
show ground;
(6)
a
public cemetery or public burial ground;
(7)
a
public garden, public recreation ground, or public reserve;
(8)
a
public road; or
(9)
a
fire brigade station.
Register No. Form No. 1.
Commonwealth of Australia.
Land Tax Assessment Act 1910-1911.
NOTICE OF APPEAL AGAINST ASSESSMENT.
<table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:33.55pt"><td colspan="3" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">I </span><span style="font-family:'Times New Roman', serif; font-variant:small-caps">hereby give Notice </span><span style="font-family:'Times New Roman', serif">that I appeal against the Assessment of Land Tax under the above register number, and contained in Notice of Assessment issued by the</span></p></td></tr><tr style="height:6.95pt"><td style="width:32.74%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">Commissioner of Land Tax,</span></p></td><td style="width:54.84%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif">under date</span></p></td><td style="width:12.42%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">for the</span></p></td></tr><tr style="height:8.35pt"><td style="width:32.74%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">reasons that:—</span></p></td><td style="width:54.84%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:12.42%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr></tbody></table>
<table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:26.55pt"><td colspan="2" style="padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">And I require that the Assessment be altered accordingly.</span></p><p style="margin-left:28.8pt; text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">I appeal against the Assessment to the</span></p></td><td style="width:7.96%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:20.32%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">Court</span></p></td></tr><tr style="height:24.9pt"><td style="width:6.36%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif">at</span></p></td><td style="width:65.36%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:middle; background-color:#ffffff"><p style="text-align:center; font-size:11pt"><span style="font-family:'Times New Roman', serif; font-style:italic">Signature</span></p></td><td style="width:7.96%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:20.32%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:39.15pt"><td style="width:6.36%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:bottom; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif; font-style:italic">Date</span></p></td><td style="width:65.36%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:middle; background-color:#ffffff"><p style="margin-right:7.2pt; text-align:right; font-size:11pt"><span style="font-family:'Times New Roman', serif; font-style:italic">Postal Address for</span></p><p style="margin-right:7.2pt; text-align:right; font-size:11pt"><span style="font-family:'Times New Roman', serif; font-style:italic">Service of Notices</span></p></td><td style="width:7.96%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:middle; background-color:#ffffff"><div style="width:100%; height:39.15pt; display:inline-block; overflow:visible"><p style="text-align:center; font-size:11pt"><span style="height:0pt; text-align:left; display:block; position:relative; z-index:5"><img src="image.008.png" width="11" height="39" alt="" style="margin-top:2.94pt; margin-left:1.38pt; position:absolute"></span><span style="font-family:'Times New Roman', serif; font-style:italic">}</span></p></div></td><td style="width:20.32%; padding-right:0.5pt; padding-left:0.5pt; vertical-align:top; background-color:#ffffff"><p style="text-align:justify; font-size:11pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr></tbody></table>
Note.—Notwithstanding this appeal the tax as assessed must be paid by the due date, otherwise a penalty of 10 per cent. of the amount of the tax must be paid in addition.
If the appellant succeeds on the appeal, the amount of tax paid by the appellant in excess of the amount determined by the decision on the appeal will be repaid to him.
TABLE I.
PRESENT VALUE OF £1 PER ANNUM PAYABLE FOR ANY NUMBER OF YEARS PROM 1 TO 100.
(Annual payment assumed to be spread uniformly over year.)