AF00106663 Bankruptcy Solomons Tamworth - Flipbook - Page 49
IN THE SUPREME COURT OF
NEW SOUTH WALES.
IN BANKRUPTCY.
RE
St. 1675
Common Firms—and directions fonting up the within General Worm for proof of Den,
Proof by Agent.
I am the Agent (Attorney or in the employ) of the undermentioned Creditor,a ciyi,_
am duly authorized by [here state authority to make this Affidavit, and it is within m
own knowledge that the debt hereinafter deposed to was incurred, and for the consideration stated. My means of knowledge are :—
Goods sold and
delivered.
For that the said
delivered goods to the said Bankrupt to the value of £
of which appear by the Account hereunto annexed.
Debt on Promissory Notes.
For that
on the
day of
18 , made and delivered his Promissory Note, payable
months after
date to
or order, for £
[with interest at
per cent.] [and the said
indorsed the same to
] and which
Note remains unpaid [although duly presented—and due notice of dishonor was given
to the said Bankrupt] : and it is hereunto annexed for inspection.
Debt on acceptante of Bill of
Exchan;e.
For that the said Bankrupt accepted [or indorsed] a Bill of Exchange drawn upon
by
dated the
day of
18 , at
months, in the sum of £
[with interest at
per cent.] ; [and the said
indorsed the same to
] and which
Pill remains unpaid, although duly presented—and due notice of dishonor was given to
the said Bankrupt : and is hereunto annexed for inspection.
OF
El FART.
OF
Debt on Rent.
PROOF OF DEBT FOR
sold anal
, the particulars
For that the said Bankrupt was the occupying tenant of a dwelling-house and f
situate at
, the property of the said
from the
day of
18 , to the
day of
18 , at the rate or rent of
per
and said sum of
was fairly due under the tenancy, at the date of
Sequestration, after allowing all proper credits.
OF
OF
Official Assignee of
Trustee.
Debt for Wages
or Salary.
For that the said
was the hired
[household servant] or [farm servant] or [clerk in the service of] the said Bankrui t,
from the
day of
18 , to the
day of
18 , on a hiring [or engagement] for a period of
[or by the
] at the rate of
by the
; and said sum of £
was fairly due in respect of such
service at the date of Sequestration, after allowing all proper credits.
Form or Statement of Set-off.
The Bankrupt has Set-off against the said sum of
to the
extent of £
, the nature and particulars and dates of which are hereunto
annexed*; and this proof is for the difference only between said sums, being £
Statement where
Securities held.
I [or the said
] hold [or ha
] '
a Security against the said debt of £
; which security [I or he] valm
at £
It consists of the Instruments set out in tie Papei
hereunto annexed*—which shows the dates and also the property of persons affected by
the security, and this Proof is for the difference only between said two sums of £
and £
being £
Annex the same accordingly.
