Schedule (A) Form of Rate
An assessment to the sewer rate [or other rate,&c., as the case may be] for the [name the district or town], made this day of in the year of our Lord 18 , after the rate of pence in the pound, by virtue of the [name special Act].
| No. on the rate. | Name of person rated. | Name of the owner of property rated. | Description and situation of property. | Gross annual value. | Full net annual value. | Rate atd. in the pound. | Amount of drainage rate (if any). |
|---|---|---|---|---|---|---|---|
Signed by us this day of in the year of our Lord
A.F.M
C.D.
E.F. _________________Improvement
G.F. Commissioners
L.K.
L.M.