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Form No. 30. — Reg 37. cancelled, and the said society is hereby registered as a branch of the New Zealand. (Signature.) Date : day of ,18 . "Friendly Societies Act, 1877." APPLICATION FOR THE CONVERSION OF A REGISTERED SOCIETY INTO A BRANCH. ' Form No. 33— Reg. 39. Name of society : Register No. New Zealand. To the Registrar of Friendly Societies. Application to register the above-mentioned society as a branch .._ ~. „ ... , 10 _» of the is made by the three persons whoie names are "Friendly Societies Act, 18/7. subscribed at the foot hereof. ™ IW_£S£ ___£ of the resolution passed at a _ INSTRUMENT OF DISSOLUTION, general meeting of the said society, of which notice was duly Name of society : given, held on the day of , 18 ,by which it Register No. was determined that the said society should become a branch Instrument of dissolution of the , made the under this Act of the above-mentioned . day of 18 , pursuant to "The Friendly Societies (b.) A copy, marked B, of the rules of tho first-mentioned Act, 1877," section 26, and signed by [in the case of a society [ .narked to show the amendments mado at the above- society not a Friendly Society three-fourths of the members ; mentioned meeting]. but in the case of a Friendly Society] five-sixths in value of tho [(c) Two copies, each marked C, of Buch amendments of members, including honorary members, if any, and by every rules]. person for tho time being receiving or entitled to receive any f Secretary of the first- relief, annuity, or other benefit from the funds of the society }. named society. [except whose claims have been duly satisfied or have . Chairman of the gene- been provided for (Slate in what manner such provision has been \ ral meeting. made)]. f Secretary of the second- It is agreed and declared as follows : — ). named society. 1. The liabilities and assets of the society are the following Registered office : [Sere set them forth in detail]. Date: day of , 18 . 2. The number of members is , and the nature of -. .. -. : z ; -, ~77 7. T T~r their interests in the society respectively is as follows: *If no amendments of rules were made at the meeting, the words in „ r_ • . i *_•_. .i. '_.. . . r brackets should be struck out. 3- nw society has no creditors other than such members [or if there be any, stale the amount due to them and the provision to be made for its payment]. 4. The funds and property of the society shall be appropriated Form No. 31.— Reg. 37. an(t divided in the following manner [or in such manner as the Registrar may award]. New Zealand. [Here insert any other provisions the society desires io make as • to the dissolution.] " Friendly Societies Act, 1877." i No. of Votes Signatures of Members. of each DECLARATION TO ACCOMPANY APPLICATION FOR Member. CONVERSION OF A REGISTERED SOCIETY INTO — 1 _ A BRANCH. Name of society: Register No. AY.:, of , chairman of the meeting at which a ~. ~ ~ ~ ' resolution was passed for the conversion of the above-men- * Signatures of persons receiving or entitled to receive any tioned society into a branch of tho , and of rehef, annuity, or other benefit Irom the funds of the society; , secretary of the first-mentioned society, do solemnly (belieduie.) and sincerely declare that the said resolution was duly passed by three-fourths of the members present and entitled to vole List of Members who have not signed the foregoing No. of Votes at a general meeting of the said society, of which notice was Instrument. Member. duly given, held on the day of , 18 , and m that tho amendments to the rules of the said society, accompanying this declaration, were duly made at the Baid meeting. And wo make this solemn declaration conscientiously believing the same to be true, and by virtue of an Act of the General Assembly of New Zealand intituled " The Justices of tho Peace TTTI 77; I 7 ', : ~, _—. ,, — Act 1866" ti.li. —All signatures by mark only must be attested by a Made and subscribed at , in tho witness who does not sign as a member. Colony of New Zealand, this day of , in the year of our Lord one * These consents may be given separately. thousand eight hundred and , before mo [one of Her Majesty's Justices of the Peace in and for the said colony]. (Signed) ' of the general meeting. V B . Secretary of the Society. Form No , zi.—Reg. 39. New Zealand. Form No. 32.— Reg. 38. New Zealand. " Friendly Societies Act, 1877." "Friendly Societies Act, 18877." DECLARATION TO ACCOMPANY INSTRUMENT OF DISSOLUTION. CONVERSION OF A REGISTERED SOCIETY INTO A Name of society: BRANCH. Register No. Name of society: Zj 0 - , one of the trustees [or we, and Register No. three members and the secretary] of the above-named The registry as a separate society of tho is hereby society, do solemnly and sincrely declare that, in making the