678.

Ch. 31. No. 1.] Companies.

 

No. 87. (Rules 171 and 175.)
List of Dividends or Composition.
[Name of Company.]

I hereby certify that a Dividend (or Composition) of in the Dollar was
declared payable on and alter the day of 19 , and that the
Creditors whose names are set forth below are entitled to the amounts set opposite
their respective names, and have been paid such amounts except in the cases specified

as unclaimed.
Dated the day of 19

Liquidator.
To the Registrar.

Amount of Dividend (or

: |} espe ces - Amount of Composition).
Surname. Christian Ni Proof. ns

Paid. Unclaimed.

 

 

Lo

Total § | |

 

This List is required in duplicate.