lOO 



GREAT BRITAIN AND IRELAND - MISCELLANEOUS 



Appendix I. — Form of Return for Dtdies on Land Values. 



DUTIES ON LAND VALUES 



FINANCE (19OQ-IO) ACT, igio 



Reference : to be quoted 

 in all communicatton 



RETURN TO BE MADE BY AN OWNER OF LAND OR BY ANY PERSON 



RECEIVING RENT EST RESPECT OF I^ND. 



(Penalty for hiilure to make a due Return, not exceeding £'=,0). 



Parish 



Number of Poor Rati- 



Name of Occupier . . 



Descri ption ot Propertj' 



Situation of Propeity. 



Estimated extent. . . 



Gross Estimated Rent- 

 al (or Gross Value 

 in Valuation List*) . 



Rateable Value ... 

 (* Applicable to the Metropolis only). 



Particulars 

 extracted 

 from the 



Rate books 



This space is not for the use of the person making the RetHin. 



Acres 



Roods 



IMPORTANT. — As the Land is to be valued as on ^oth April, 1909, the particulars skotiid 

 be furnished, so far as possible, with reference to the circximstance'i existing on tliat date. 



I. Particulars required by the Commissioners, which must be furnished 

 so far as it is in the power of the person making the Return to 

 give them. 



(d) Nature of Interest of the person 

 making the Return in the Land : — 



(i) Whether Freehold, Copyhold, or 

 lyeasehold, 



(2) II Copyhold , name of the Manor. 



(3) If Leasehold, (i ) term of lease 

 and date of commencemeut (includ- 

 ing, where the lease contains a cov- 

 enant for renewal, the period for 

 which the lease may be renewed), 

 and (ii.) name and address of lessor 

 or his successor in title. 



3 (i) 



3 (ii.) 



{e) Name, and precise situation of 

 the I,and. 



