We, being entitled to be included in the roll for the election of members of the Lord Howe Island Board, nominate [full name in block letters] of [place of residence as enrolled] as a candidate for that election.
Date—
| Name (in full) of each nominator | Signature of each nominator | Place of residence (as enrolled) of each nominator | Occupation of each nominator |
| | | | |
| | | | |
I, [name of candidate], consent to the nomination.
Candidate’s signature—
Note.
This form must be completed by at least 2 nominators.
Form 2 Application for lease in perpetuity for the purpose of residence
I, [full name], being an Islander, apply for a lease in perpetuity of the land described below (and shown on the accompanying sketch—required if the land is not a measured portion) for the purpose of residence.
I have made the declaration on the back of this form.
Signed this day of , 20 .
Signature—
Address—
To the Chairperson,
Lord Howe Island Board.
Note.
The following declaration is to be published on the back of this form.
Declaration by applicant
I, [full name], of [address], solemnly declare and affirm that I am the applicant for a lease in perpetuity for the purpose of residence of the land described on the front and that the answers to the questions in the Schedule are correct.
Schedule
| 1 | On what grounds do you claim to be an Islander? |
| 2 | What is the date and place of your birth? |
| 3 | (a) What is your marital status?(b) State the age and sex of any children living with you, or dependent on you. |
| 4 | Do you or does your spouse or any child mentioned in answer to question 3 hold any land? If so, give area, location, particulars of title and state by whom it is held. |
| 5 | Are you already residing on the land the subject of this application? If so, state how long you have been in residence. |
| 6 | Are there any improvements on the land the subject of this application? Give brief particulars and estimated values of the improvements. |
I make this solemn declaration as to the above matters according to the law in this behalf made and subject to the punishment by law provided for any wilfully false statement in any such declaration.
Schedule Schedule 1 - Lord Howe Island Regulation 2014 - Forms | Zoe
Signature of Declarant—
Made before me [name of witness], a [qualification of witness], at this day of , 20 .
Signature of a Justice of the Peace, Commissioner for Affidavits or Notary Public—
I [insert name of witness], a *Justice of the Peace/*Commissioner for Affidavits/*Notary Public, certify the following matters concerning the making of this statutory declaration by the person who made it—
1 *I saw the face of the person or *I did not see the face of the person because the person was wearing a face covering, but I am satisfied that the person had a special justification for not removing the covering.
2 *I have known the person for at least 12 months or *I have confirmed the person’s identity using an identification document and the document I relied on was [describe identification document relied on].
I, [full name] apply for a special lease for the purpose of [state use intended to be made of land] of the land described below (and shown on the accompanying sketch—required if the land is not a measured portion)—
I have made the declaration on the back of this form.
Signed this day of , 20 .
Signature—
Address—
To the Chairperson,
Lord Howe Island Board.
Note.
The following declaration is to be published on the back of this form.
Declaration by applicant
I, [full name], of [address], solemnly declare and affirm that I am the applicant for a special lease of the land described on the front and that the answers to the questions in the Schedule are correct.
Schedule
| 1 | (a) Are you the holder of a lease in perpetuity for residence under section 21 of the Lord Howe Island Act 1953?(b) If you are not the holder at present, have you applied for such a lease? |
| 2 | (a) Are you already using the land the subject of this application?(b) If so, for what purpose and for how long? |
| 3 | Are there any improvements on the land the subject of this application? Give brief particulars and estimated values of the improvements. |
I make this solemn declaration as to the above matters according to the law in this behalf made and subject to the punishment by law provided for any wilfully false statement in any such declaration.
Signature of Declarant—
Made before me [name of witness], a [qualification of witness], at this day of , 20 .
Signature of a Justice of the Peace, Commissioner for Affidavits or Notary Public—
I [insert name of witness], a *Justice of the Peace/*Commissioner for Affidavits/*Notary Public, certify the following matters concerning the making of this statutory declaration by the person who made it—
1 *I saw the face of the person or *I did not see the face of the person because the person was wearing a face covering, but I am satisfied that the person had a special justification for not removing the covering.
2 *I have known the person for at least 12 months or *I have confirmed the person’s identity using an identification document and the document I relied on was [describe identification document relied on].
[insert signature of witness]
Date—
Form 4 Lease in perpetuity for the purpose of residence
Pursuant to section 21 of the Lord Howe Island Act 1953 (the Act), I, the Minister administering the Act, grant to [name of lessee], his or her executors, administrators and assigns a lease in perpetuity for the purpose of residence of a parcel of land containing [specify number of hectares] hectares and being measured portion [specify portion details] situated on Lord Howe Island (not including any roads within the boundaries of that portion) being Lease in Perpetuity No. [specify No.] (shown in the attached plan), together with all rights, easements and appurtenances to hold the land in perpetuity subject to the Act and the regulations made under the Act and to the following conditions—
Persons dealing with this lease are warned that a search should be made in the Lord Howe Island office of the Lord Howe Island Board in order to ascertain whether the lease is still current or whether it has been forfeited or cancelled.
Form 5 Application for consent to transfer a lease or part of a lease or to sublet a lease
Pursuant to section 23 of the Lord Howe Island Act 1953, I, [full name], of [address], the holder of the lease(s) specified in Schedule 1, apply for the consent of the Minister (and the approval of the Governor) to transfer such lease(s) or part(s) of such lease(s) by way of (sale, mortgage) or sublet such lease(s) [give particulars of subletting] to [proposed transferee or sublessees], of [address].
Declaration marked “A” has been made by me.
I enclose a certified copy of the original agreement or contract for the sale of such lease(s) or part(s) of such lease(s) and apply for approval of that agreement or contract. [Strike out if there is no written agreement or contract]
I also enclose a sketch showing the subdivision line or lines and indicating the part(s) of the lease(s) proposed to be transferred. [Strike out if it is proposed to transfer whole of lease(s)]
Schedule 1
| Class of Lease (Perpetual or Special) | No of Lease | Area | Portion No |
| | | | |
| | | | |
Signature of person proposing to transfer or sublet—
Address to which notices are to be sent—
To the Chairperson,
Lord Howe Island Board.
Declaration “A” by persons proposing to transfer or sublet
I, [full name], of [address], being the holder of the lease(s) specified in Schedule 1, solemnly declare and affirm that the answers to the questions in Schedule 2 are correct in every particular.
Schedule 2
| 1 | What is the date of your birth? |
| 2 | What are your reasons for wishing to transfer your lease(s) or part(s) of such lease(s) or sublet your lease(s)? State fully. |
| 3 | Are there any improvements on the land proposed to be transferred? Give brief particulars and estimated values of the improvements. |
| 4 | What is the amount—(a) of the consideration agreed on?(b) of the sum for goodwill included in the consideration? |
| 5 | Have you made any agreement or contract for the sale of the lease(s) or part(s) of such lease(s)? |
| | If so, a certified copy should be lodged with this application. |
| 6 | Is the person to whom you propose to transfer your lease(s) or part(s) of such lease(s) or sublet your lease(s) an Islander? |
| 7 | If the person to whom you propose to transfer your lease(s) or part(s) of such lease(s), or sublet your lease(s), as the case may be, is not an Islander, is there any Islander residing on the Island who desires and is in a position to take such transfer or sublease? Indicate the grounds for your answer to this question. |
I make this solemn declaration as to the above matters according to the law in this behalf made and subject to the punishment by law provided for any wilfully false statement in any such declaration.
Signature of Declarant—
Made before me [name of witness], a [qualification of witness], at this day of , 20 .
Signature of a Justice of the Peace, Commissioner for Affidavits or Notary Public—
I [insert name of witness], a *Justice of the Peace/*Commissioner for Affidavits/*Notary Public, certify the following matters concerning the making of this statutory declaration by the person who made it—
1 *I saw the face of the person or *I did not see the face of the person because the person was wearing a face covering, but I am satisfied that the person had a special justification for not removing the covering.
2 *I have known the person for at least 12 months or *I have confirmed the person’s identity using an identification document and the document I relied on was [describe identification document relied on].
[insert signature of witness]
Date—
Declaration “B” by proposed transferee or sublessee
I, [full name], of [address], solemnly declare and affirm that I am the person to whom [the proposed transferor] proposes to transfer the lease(s) or part(s) of such lease(s) (or to sublet) the lease(s) particularised in Schedule 1, that the transaction is entered into in good faith, and that Schedule 3 contains a true statement of all lands now held by me, my spouse and my children living with me or dependent on me.
Schedule 3
| Class of holding | No of holding | Area | Portion No | By whom held (spouse or child) |
| | | | | |
| | If no land is held write “Nil”. | |
I solemnly declare and affirm that my sole object in acquiring the land is in order that I may hold and use it for my own exclusive benefit, and that the answers to the questions in Schedule 4 are true and correct in every particular.
Schedule 4
| 1 | Are you an Islander? If so, state the grounds on which you claim to be one. |
| 2 | What is the date and place of your birth? |
| 3 | (a) What is your marital status?(b) State the age and sex of any children living with you or dependent on you. |
| 4 | What is the amount—(a) of the consideration agreed on?(b) of the sum for goodwill included in the consideration? |
| 5 | What are your reasons for wishing to acquire the subject lease(s) or part(s) of such lease(s)? Indicate the use you intend to make of the land. |
I make this solemn declaration as to the above matters according to the law in this behalf made and subject to the punishment by law provided for any wilfully false statement in any such declaration.
Signature of Declarant—
Address to which notices are to be sent—
Made before me [name of witness], a [qualification of witness], at this day of , 20 .
Signature of a Justice of the Peace, Commissioner for Affidavits or Notary Public—
I [insert name of witness], a *Justice of the Peace/*Commissioner for Affidavits/*Notary Public, certify the following matters concerning the making of this statutory declaration by the person who made it—
1 *I saw the face of the person or *I did not see the face of the person because the person was wearing a face covering, but I am satisfied that the person had a special justification for not removing the covering.
2 *I have known the person for at least 12 months or *I have confirmed the person’s identity using an identification document and the document I relied on was [describe identification document relied on].
I, [full name] of [address] in consideration of the sum of [specify sum] (the receipt of which is acknowledged) transfer by way of [sale, mortgage] to [full name] of [address] all [my, its] estate and interest in the land described as follows—
| Class of lease (perpetual or special) | No of lease (indicate if part only) | Area | Portion No |
| | | | |
| | | | |
Signed at the day of , 20 .
Signed in my presence—
Witness
Signature of transferor—
I accept this transfer.
Signed in my presence—
Witness
Signature of transferee—
Notes—
Memorandum of non-revocation of power of attorney
[I/We] have had no notice of revocation of the Power of Attorney registered No [specify No.] Miscellaneous Register under the authority of which [I/we] have just signed the transfer.
I, [full name] of [address] being the holder of the land described below, surrender the land to the Crown, intending that the land will vest in the Crown as Crown land.
[Description of land to be surrendered that will enable it to be identified]
Signed at this day of , 20 .
Signature of surrenderor—
Signed in my presence by [full name of surrenderor] who is personally known to me.
Signature of Justice of the Peace—
I, [full name of mortgagee if surrender is by mortgagor], the mortgagee under Mortgage No [specify No], join in this surrender.
Signed at this day of , 20 .
Signature of mortgagee—
Signed in my presence by [full name of mortgagee] who is personally known to me.
Signature of Justice of the Peace—
I, [full name of mortgagor if surrender is by mortgagee], being the mortgagor of the land described above, join in this surrender.
Signed at this day of , 20 .
Signature of mortgagor—
Signed in my presence by [full name of mortgagor] who is personally known to me.
Signature of Justice of the Peace—
Accepted for and on behalf of the Crown this day of , 20 .
Signature of Minister—
Signed in my presence by the Minister administering the Lord Howe Island Act 1953, who is personally known to me.