C-9 - Farmers’ Clubs Act

Schedule Disposition versions

1977-12-31

3

(Section 40)

List and Certificate of Subscriptions

Farmers’ Club of ..............

I, the undersigned, president (vice-president or secretary-treasurer) of the Farmers’ Club of .............. declare on oath that (here state the names, occupations and post-office addresses of all the members of the club, with the sums paid by each opposite to their respective names), members of the said club, have paid their subscriptions for the current year; that the said sum consists of coin and bank-notes current in Québec and not of promissory notes or other securities; that out of the said sum the sum of .............. has been expended in discharge of claims against the club, and that there is now on hand the sum of .............. dollars, the proceeds of the subscriptions, available according to law.

I further declare that the secretary-treasurer of this club has given a bond to the amount of $400 subscribed by (names, occupation, residence), who are fully solvent to the said amount, a copy of which bond is hereunto annexed.

(Date) ..............

(Signature)

A. B.,

President,

(Vice-President or Secretary-Treasurer.)

Sworn before me, at .............. this .............. day of .............., 19..............

E. F.,

Justice of the Peace.

R. S. 1964, c. 113, form 3.