the peace for the division of

in the said [county, or as the case may be] that he may pay and apply the same as by law directed, and may render the overplus, if any, on demand to the said ; and if no such distress can be found then that you certify the same to me to the end that such proceedings may be had therein as the law doth appertain.

Given under our [or my] hand and seal this day of

hundred and

in the year of Our Lord one thousand eight in the [county] aforesaid.

at

The following form is given by the Waterworks Clauses Act, 1863, 26 & 27 Vic. c. 93, which is incorporated with this Act:Order to secure Reservoir.

To A.B., of

We, the undersigned, two of Her Majesty's justices of the peace acting for the [county] of do hereby order and direct you [and such person or persons as you may require to aid and assist you herein] forthwith to lower the water in the [here describe the reservoir and the extent to which the water is to be lowered], and to do all such works and things as may be requisite to repair and make secure the said reservoir [and you shall do as little injury as possible to the property of the And for acting as you are hereby directed

this shall be your sufficient warrant].

Given under our hands this

18

day of

C.D.

E.F.

The next two forms are given by the Public Health (Water) Act, 1878:

FORM U.

Form of notice requiring owner to provide a supply of water for an occupied house.

To

the owner of the house occupied by [state name of occupier], and situated at [give such description as may be sufficient to identify the premises], within the district of [describe the local authority].

Whereas it appears to the above-named [local authority] on the report of their [inspector of nuisances or their medical officer of health, as the case may be] that the said house has not within a reasonable distance an available supply of wholesome water sufficient for the consumption and use for domestic purposes of the inmates of the house by reason of the existing supply not being [wholesome or sufficient, or within a reasonable distance, as the case may be], and that the requisite supply can be provided at a reasonable cost; and whereas the said [local authority] are of opinion that such supply ought to be provided at your expense as the owner of the said house, or defrayed as private improvement expenses:

Now, therefore, we, the said [local authority], in pursuance of the Public Health (Water) Act, 1878, do hereby require you to provide an available supply of wholesome water sufficient for the consumption and use for domestic purposes of the inmates of the said house within a reasonable distance from such house, and to do all such works as may be necessary for that purpose within [state the time] from the date of the service hereof.

Dated this

day of

(Signed)

Clerk to the said [local authority.]

FORM (V.)

Form of second notice to serve where the requirements of the first have not been complied with.

To

the owner of the house occupied by [state name of occupier], and situate at [give such description as may be sufficient to identify the premises], within the district of [describe the local authority].

[local authority], in pursuance of the Public Health (Water) Act, 1878, served on you a notice bearing date the

day

of requiring you as the owner of the said house to provide an available supply of wholesome water sufficient for the consumption and use for domestic purposes of the inmates of the said house, within a reasonable distance from such house, and to do all such works as might be necessary for that purpose within [state the time] from the date of the service of such notice:

day of

And whereas the said notice has not been complied with : Now therefore, we, the said [local authority], do hereby give you notice, that if the requirements of the said first notice dated the are not complied with within one month from the date of the service hereof, we [describe local authority] will ourselves provide a supply of water for the said house, and do all necessary works for that purpose, and that the cost which may be incurred therein will be recovered from you summarily, or be recovered as private improvement expenses.

Dated this

day of

(Signed)

Clerk to the said [local authority].

The two following forms are given by the Cemeteries Clauses Act, 1847 :

FORM W.

Form of Grant of Right of Burial.

By virtue of [here name the Special Act] we [here state the name or description of the Company], in consideration of the sum to us paid by

of.

do hereby grant unto the said burial [or the right of burying

of

the exclusive right of bodies, as the case may

be] [or the right of placing a monument, tablet, or gravestone] in [here describe the ground intended for the exclusive burial, or for placing a monument, tablet, or gravestone, as the case may be, so as to identify the same, and if a place of exclusive burial, add, "numbered on the plan of the cemetery made in pursuance in per

of the said Act"], to hold the same to the said petuity [or the period agreed upon] for the purpose of burial [or as the case may be].

Given under our common seal [or under our hands and seals, as the case may be], this

of our Lord

day of

in the year

hereby assign unto the said C.D. the exclusive right of burial in [here describe the place], and numbered on the plan of the cemetery made in pursuance of the said Act, which was granted to me [or unto A.B. of ] in perpetuity [or as the

day of

case may be] by [here state the name of the Company] by a deed of grant bearing date the and all my estate, title, and interest therein, to hold the same unto the said C. D. in perpetuity [or as the case may be, for the remainder of

the period for which the same was granted by the said Company], subject to the conditions on which I held the same immediately before the execution hereof.

Witness my hand and seal this

I

FORM Y.

day of

Form given by Burials Act, 1880.

of

Form of Certificate of Burial.

the person having the charge of (or being responsible for) the burial of the deceased, do hereby certify that on the

aged

day of

, A.B., of

, was buried in the churchyard [or graveyard] of

the parish [or district] of

To the Rector [or as the case may be,] of

The following Forms are published by the Local Government Board in their bye-laws:

FORM Z.

Form of notice that Building is unfit for human habitation.

To

District of.

Whereas, by a statement in writing under the hand of Medical Officer of Health

(or Surveyor) of the sanitary authority for the district of

of which statement a

copy is contained in the schedule hereunto annexed, it has been certified to the said sanitary authority that a certain building or part of a building situate at in the said

district is unfit for human habitation.

And whereas it has been shown to the said sanitary authority that you are the owner of such building or part of a building; Now, I clerk of the said sanitary authority, do hereby give you notice that, unless on or

before the

day of