APPLICATION NO: _______________

IN THE HIGH COURT OF THE COOK ISLAND HELD AT RAROTONGA

(LAND DIVISION)

Toka Pipi Ben                     

APPLICANT

________________________________________

APPLICATION FOR SUCCESSION

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DATE OF HEARING:

REC BOOK:

DECISION:

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  JUDGE:

  JUSTICE OF PEACE

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FEE:     $10.00 for the first 5 lands$2.00 for each additional land

ADVT   $15.00

CHECKING ORDER:  $10.00

ORDER  & SEALING:   $15.00

REGISTRATION:  $ 6.00

RECEIPT: 

DATE RECEIVED: ______/_____/____

Please take note that a re-advertisement fee

of $15.00 is payable every time this application is adjourned

Received By:   _____________________