| 10,000 9-05 |
|
Form No. 36 |
STATUTORY DECLARATION of____________________________________
In the matter of his Homestead, the _________1/4 Sec._____Tp._____Rge._____M.
_____________________________________
|
-
What is your name, age and Post Office address?
Ans.________________________________________________________________
-
Are you married or single? If married, of whom does your family consist?
Ans.________________________________________________________________
-
When did you obtain entry for the said homestead?
Ans.________________________________________________________________
-
When did you begin actual personal residence upon the said homestead?
Ans.________________________________________________________________
-
What actual residence have you since performed on the said homestead? If the period of residence is not continuous, state months or portions of months in each year.
Ans.________________________________________________________________
____________________________________________________________________
____________________________________________________________________
-
When absent form said homestead, where were you, and what were you doing?
Ans.________________________________________________________________
-
For what period have your wife and family resided with you during your residence upon the said
homestead? If not with you, where have they resided?.
Ans.________________________________________________________________
____________________________________________________________________
____________________________________________________________________
-
Have you any profession or occupation other than farming ; if so, what is it?
Ans.________________________________________________________________
-
What buildings and fencing have been erected on the said homestead, and what is the present value of each?
Ans.________________________________________________________________
____________________________________________________________________
____________________________________________________________________
-
How many horses, cattle, sheep and hogs do you own upon the said homestead?
Ans.________________________________________________________________
____________________________________________________________________
____________________________________________________________________
-
In what month and year was your house erected?
Ans.________________________________________________________________
Next page...
-
How much land has been broken and cropped on the said homestead in each year?
Ans. :-
19_ _ broke_______acres, cropped _______ acres, 19 _ _ broke _______ acres, cropped _______ acres.
19_ _ broke_______acres, cropped _______ acres, 19 _ _ broke _______ acres, cropped _______ acres.
19_ _ broke_______acres, cropped _______ acres, 19 _ _ broke _______ acres, cropped _______ acres.
-
What area of the said homestead can be brought under cultivation?
Ans.________________________________________________________________
-
What area of said homestead is hay land and what area swamp?
Ans._____________acres, hay land _____________________________acres swamp ?
-
What area of the said homestead is timber?
Ans.________________________________________________________________
-
State any special circumstances such as illness, accident or lack of means, which should be
considered by the Department in dealing with your case. Give any further information
which in your opinion should be brought to the attention of the Department?
?
Ans.________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Dated at _____________________________________________
_____________________________________________190________
|
Signature _____________________________________________
Witness to Signature _____________________________________________
|
|