AF00106663 Bankruptcy Solomons Tamworth - Flipbook - Page 51
IN THE SUPREME COURT OF
NEW SOUTH WALES.
IN BANKRUPTCY.
St. 1675
Proof by Agent.
Goods sold and
delivered.
Debt on Promissory Notes.
RE
OF
Debt on acceptance of Bill of
Exe'nan.e.
EX RARTE
OF
Debt on Rent.
PROOF OF DEBT FOR
Common Firms—and directions for filing up the within General _Form for proof of Debt.
I am the Agent (Attorney or in the employ) of the undermentioned Creditor, and
am duly authorized by [here state authority] to make this Affidavit, and it is within my
own knowledge that the debt hereinafter deposed to was incurred, and for the consideration stated. My means of knowledge are :—
sold and
For that the said
, the particulars
delivered goods to the said Bankrupt to the value of £
of which appear by the Account hereunto annexed.
day of
on the
For that
months after
18 , made and delivered his Promissory Note, payable
or order, for £
date to
per cent.] [and the said
[with interest at
] and which
indorsed the same to
was given
dishonor
of
notice
due
and
presented—
duly
[although
unpaid
remains
Note
to the said Bankrupt] : and it is hereunto annexed for inspection.
For that the said Bankrupt accepted [or indorsed] a Bill of Exchange drawn upon
dated the
by
of £
sum
the
in
months,
at
,
18
day of
per cent.] ; [and the said
[with interest at
] and which
indorsed the same to
given to
was
dishonor
of
notice
due
and
presented—
duly
Bill remains unpaid, although
the said Bankrupt : and is hereunto annexed for inspection.
For that the said Bankrupt was the occupying tenant of a dwelling-house and
situate at
OF
Debt for Wages
or Salary.
OF
, the property of the said
from the
day of
18 , to the
day of
per
18 , at the rate or rent of
was fairly due under the tenancy, at the date of
and said sum of
Sequestration, after allowing all proper credits.
was the hired
For that the said
[household servant] or [farm servant] or [clerk in the service of] the said Bankrupt,
- 18 , to the
day of
from the
18 , on a hiring [or engagement] for a period of
day of
] at the rate of
[or by the
was fairly due in respect of such
; and said sum of £
by the
service at the date of Sequestration, after allowing all proper credits.
to the
The Bankrupt has Set-off against the said sum of
, the nature and particulars and dates of which are hereunto
extent of
annexed*; and this proof is for the difference only between said sums, being
] hold [or ha
]
Statement where
I [or the said
Securities held.
[I or he] value
security
which
;
£
of
debt
said
a Security against the
It consists of the Instruments set out in the Paper
at £
dates and also the property of persons affected by
the
shows
which
annexed*—
hereunto
only between said two sums of £
difference
the security, and this Proof is for the
being £
and £
Form or Statement of Set-off.
Official Assignee of
Trustee.
* Annex the same accordingly.
