AF00106663 Bankruptcy Solomons Tamworth - Flipbook - Page 55
St.
Proof of _Debt.
111011.101111111,9217101711.0011
IN THE SUPREME COURT OF
NEW SOUTH WALES.
IN BANKRUPTCY.
No.)
Be
Bankrupt.
_Ex parte 4,1A-L)
state name of person
making the Proof.
ON
the
day of
Creditor.
ev---der--- 189 e7,
of
Where a person
proves as the Agent,
Attorney, or Clerk,
state the fact ; also
aut rity and means
of nowledge.
being duly sworn, states as follows :—
I am the
in the employ of the undermentioned
Creditor, and am duly authorized 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 :—
The above-named Bankrupt at and before the Sequestration of
Estate
and still
justly and truly indebted to
Name
crlitor.
in the sum of
Here state the cause
and particulars of
Debt, briefly, but
explicitly. (See
Forms and Directions
in Fold).
—
For that
ey urp., #et..e
c.1/4 —e
cYT 077/4
A
)
e.,CCZOA-4 e/ts-
1/1 /11/‘. OLC
When the Bankrupt
has a Set-off, or a
Security is held,
state the nature,
dates, extent, and
value, as in Fold—
which see.
over and above all just allowances.
,66ct
V/4;'
I further say the said Bankrupt has
to set-off against the said debt
of
/7— /4/ — , as far as I know and believe ; and I the said
[Creditor]
hold no security for the same ;
and ha d not received any payment in respect of the said demand, or
of any instrument securing the same, for which credit has not been
given in the abovementioned allowances.
Sworn by De onent, on the day and
yearabove-mentioned, at
befor me,
A ommissioner for Affidavits.
N.B.—A Debt must be proved by delivering or sending through the post to the Registrar in Bankruptcy, Chancery
Square, Sydney, an Affidavit (with a copy thereof) verifying the debt, with fees 2s. and is. for each document exhibited. Fees
must be paid in cash or by P.O. Order. Stamps cannot be received for Court fees.
The Affidavit must contain or refer to a statement of account showing the full particulars of the debt, and giving dates,
and shall specify the vouchers, if any, by which the same can be substantiated.
Interest at the rate of 6 per cent. only is allowed on promissory notes from date of maturity to date of sequestration,
and promissory notes must be produced.
Be particularly careful to fill up the affidavit in accordance with the printed directions on the back of this form.
The No. of the Estate must be stated on this form.
Ge 70-93
