AF00106663 Bankruptcy Solomons Tamworth - Flipbook - Page 54
IN TILE SUPREME COURT OF
NEW SOUTH WALES.
IN BANKRUPTCY.
a
•
RE
OF
EX PARTE
OF
PROOF OF DEBT FOR
St. 1675
Common Furms—and directions for filling up the within General Form for proof of Debt.
Proof by Agent.
I am the A gent (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 myown knowledge that the debt hereinafter deposed to was incurred, and for the consideration stated. My means of knowledge are :—
Ooods sold and
For that the said
sold and
delivered.
delivered goods to the said Bankrupt to the value of
, the particulars
of which appear by the Account hereunto annexed.
Debt on PromisFor that
on the
sory Notes.
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 acceptFor that the said Bankrupt accepted [or indorsed] a Bill of Exchange drawn upon
ance of Bill of
Exchange.
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.
Debt on Rent.
For that the said Bankrupt was the occupying tenant of a dwelling-house and
situate at
from the
, the property of the said
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
Ofcial Assignee of
Trustee.
or Salary.
Debt for Wages
.
For that the said
was the hired
[household servant] or [farm servant] or [clerk in the service of] the said Bankrupt,
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] value
at £
It consists of the Instruments set out in the Paper
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.
