| FORMS |
| DEPARTMENT OF AGRICULTURE. |
| Government Pasturage Lands Act |
| Application for a Licence. | Form 1. |
| 1. | Name of applicant............................................................................................... |
| 2. | Residential address............................................................................................. |
| 3. | Occupation or employment.................................................................................. |
| 4. | State whether tenant of Government owned land in the same district ...................... |
| 5. | If tenant, state area and locality of land................................................................ |
| 6. | Do you own any real property? ................. Where? .............................................. |
| 7. | Details of above.................................................................................................. |
| 8. | Do you require a keeping or a grazing licence?...................................................... |
| 9. | Details of livestock owned by applicant for which permits are required— |
| Cattle No. | Horses and Mules | Donkeys No. | Sheep No. | Goats No. |
| Bulls ............ | Stallions ........ | Jacks ............ | Rams ........... | Bucks ........... |
| Cows ............ | Mares .......... | Jennies.......... | Ewes ........... | Nannies ........ |
| Heifers.......... | Geldings ....... | Cubs under 9 mths. age | Wethers ........ | Wethers ........ |
| Steers ............ | Mules .......... | | Lambs under Kids under 9 mths. age 9 mths. age |
| Calves under 9 mths. age | Foals under 9 mths. Age | | | |
| No. ............. | No. ............. | No. .............. | No. ............. | No. .............. |
| Age ............ | Age ............. | Age ............. | Age ............ | Age ............. |
| Total |
| 10. Details of livestock kept by applicant but also owned by ...................................... .................................. of .................................... and in which applicant has the following interest— |
| ...................................................................................................... |
| ...................................................................................................... |
| Cattle No. | Horses and Mules | Donkeys No. | Sheep No. | Goats No. |
| Bulls ............ | Stallions ......... | Jacks ........... | Rams ........... | Bucks ........... |
| Cows ........... | Mares ........... | Jennies ......... | Ewes ........... | Nannies ........ |
| Heifers ......... | Geldings ........ | Cubs under 9 mths. age | Wethers ........ | Wethers ........ |
| Steers .......... | Mules .......... | | Lambs under 9 mths. age | Kids under 9 mths. age |
| Calves under 9 mths. Age | Foals under 9 mths. Age | | | |
| No. ............. | No. ............. | No. ............. | No. ............. | No. ............. |
| Age ............ | Age ............ | | Age ............ | Age ............ |
| Total |
| 11. I hereby apply for a licence and I agree to comply with the provisions of the Government Pasturage Lands Act and any regulations made thereunder. |
| Signature or Mark ............................ |
| Witness to Mark |
| ...................................................................... |
| Justice of the Peace, Minister of Religion, N.C.O. of Police. |