A digest of the law relating to public health and local government : with notes of 1073 leading cases, various official documents, precedents of by-laws and regulations, the statutes in full, a table of offences and punishments, ample indexes, &c / by George F. Chambers.
- George Frederick Chambers
- Date:
- 1875
Licence: Public Domain Mark
Credit: A digest of the law relating to public health and local government : with notes of 1073 leading cases, various official documents, precedents of by-laws and regulations, the statutes in full, a table of offences and punishments, ample indexes, &c / by George F. Chambers. Source: Wellcome Collection.
528/556 page 156
![A.D. 1875. Claim of Proxy. To the chairman of the local board for the district of This day of 18 . I the undersigned having been appointed by of owner [or owners] of the property herein-after described which is situated in the parish of to vote as his [or their] proxy pursuant to the provisions of the Public Health Act, 1875, claim to have my name inserted in the register of owners and proxies for the district of as such proxy. I herewith transmit to you (a) the writing under the hand [or hands, or in the case of a corporation the seal] of appointing me such proxy. I also state that the interest or estate which has [or have] - in such property and the amount of the rent-service which he [or they] receives or pays [or pay] in respect thereof and the names of the persons from whom he [or they] receives [or receive] or to whom he [or they] pays [or pay] such rent-service are set forth in the form hereunder written. Description of Property. (6) In respect of which tlie appointor has an estate or interest of (c) And in respect of which the appointor re- ceives in rent- service the sum of {d) From (e) And in respect of which the appointor pays in rent- service the sum of (_/■) To ig) £ s. d. £ s. d. Signature of proxy. Address (A) of proxy. (a) If the appointment itself is not sent, insert the words an attested copy of. (6) Describe the property by its name, situation, or the iiame of the occupier, or any other designa- tion by which it may be identified. (c) Describe the estate or interest, as an estate in fee shnple, of freehold, a term of years, and whether it is held by the appointor solely or jointly with others. (d) If the property is let by the appointor, insert the amount of rent received from each tenant, (c) Insert name of tenant or tenants. (7 ) If the appointor is a lessee paying rent, insert the amount of all the rent he pays, (y) Insert the name of the lessor. (/i) This need not be the proxy's residence, but i^hould be some address within the district](https://iiif.wellcomecollection.org/image/b20386643_0530.jp2/full/800%2C/0/default.jpg)
