List and Certificate of Subscriptions for the Year
AGRICULTURAL SOCIETY NO. .............. OF THE COUNTY OF ..............
I, the undersigned, president, (vice-president or secretary-treasurer) of the Agricultural Society of .............. declare on oath that (here state the names, occupations and post-office addresses of all the members of the society, with the sums paid by each, opposite to their respective names), members of the said society, 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 society; and that there is now on hand the sum of .............. dollars, the proceeds of the said subscriptions, available according to law.
I further declare that the secretary-treasurer of this society has given a bond to the amount of $800 subscribed by (names, occupation, residence), who are fully solvent to said amount, a copy of which bond is hereunto annexed.
(Date) ..............
A. B.,
President,
(Vice-President or Secretary-Treasurer)
Sworn before me, at .............., this .............. day of .............., one thousand nine hundred and ..............
E. F.,
Justice of the Peace.