Page 4 Advertisements Column 1

Patea Mail, Volume XII, Issue 12, 14 May 1886, Page 4

“REGISTRATION OF ELECTORS ACT, 1879.’ Claim for Enrolment. To the Registrar of the Electoral District of (A) I HEREBY claim to "have ray name inserted on the Electoral Roll of (B) And I declare that my name, place of abode, and occupation [or addition] are correctly stated at the foot hereof ; and that 1* have resided within the Colony oi New Zealand for twelve months, and within the said district for the rfx months immediately preceding the date thereof. ...(Name, Datid the day of/ .....(Address.) 1886. ( ... ] (Occupation.) Signed and declared by the claimant this day of , in the year 1886, before mcAn Elector of the District , or Registration Officer , or Justice of the Peace. *Notb.— -When the claim is in respect of a qualification other th m residence, state particulars of same, and omit reference to residence. S) o‘j =« ® -i •-* r* ►> ® « or j b so 2Ts?'-" 3 ® sb m cd sr — * S O o* a S <e ffl ffll ~ 53 00 *-< 03’ a M JO M g or o Sw’ rs H. a “ O 3 ® 3 o o 9 <?» 3 _ Sr. «* 3 ~ ® i.3 IS S*^. SO S 2. CL _ 3 o-S ffl 3 2 °* ” sro ft » a* 3 a « • —...9 P. - —... - O'- £3 2 se 2 » ? P »o o «» ® td 3 o §■« » SiS-5-a a ® 8* S’ ~ 3-9 » 2. ® I - «. a. o a* ® a -S» ■ ® O 3 sr a - ??- » 2. g> a - o' frs. ? Qo® sT O o 3 * <%■ o j - ' - 3.S o •» o 2 3 ►Q - a 3* »s o S 2 S os oq *-»• 00 s ** 3 {9 ’ o* z = « 3 - r*s* cr ® ® *' at 3 ' 3 2 CD ~ » 9 S- 2. I? Vs ® “5 *-». 80 S3 -5-S----5# 9D a 2. a. a «. e—■ - 3-r -rSt' ® *-<3 9 O 9 3 o o O gt 9 B 3 9 3 9* O* 9 ® O ® a 8 8. 3»*'=s fcf H 5*3 H « HT M © k xr tel >H QC .^5 ffl >3 O tel a o QQ a ffl o > 53 a « V ffl ffl ffl Kj <o ffl t> ffl a ffl w ffl t-3 kffl O 02 a ffl > a OQ ffl S ffl ffl a S3 o ffl ffl 00 ffl O ffl, ffl ffl

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