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Statutes of Northern Ireland


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PAWNBROKERS ACT (NORTHERN IRELAND) 1954

PAWNBROKERS ACT (NORTHERN IRELAND) 1954 - LONG TITLE

An Act to consolidate with amendments the law relating to
pawnbrokers and for related purposes.{1}
[21st December 1954]
The Act is prospectively repealed by the Consumer Credit Act, 1974
(c.39)

Interpretation.

PAWNBROKERS ACT (NORTHERN IRELAND) 1954 - SECT 1

1.(1) In this Act, unless the contrary intention appears, the
expression

"constable" means a member of the Royal Ulster Constabulary of
whatsoever rank;

Definition spent

"pawnbroker" includes any person who carries on the business of
taking goods and chattels in pawn, and in particular (but without
prejudice to the generality of the foregoing words of this
definition) includes any person who

(a)receives or takes of or from any other person any goods or
chattels by way of security for the repayment of any sum of money
not exceeding fifty pounds advanced thereon; or

(b)purchases, or receives or takes in, goods or chattels and pays
or advances, or lends, thereon any sum of money not exceeding fifty
pounds, with or under an agreement or understanding expressed or
implied or from the nature of the transaction to be reasonably
inferred that those goods or chattels may be afterwards redeemed or
purchased on any terms;

"pawner" means a person delivering an article for pawn to a
pawnbroker;

"pledge" means an article pawned with a pawnbroker;

"redemption period" means a period, commencing on the day next
following the date of pawning, within which a pawnbroker may not
lawfully sell or dispose of a pledge;

"shop" includes a dwelling-house or warehouse or other place of
business or place where business is transacted; and

"unfinished goods or materials" includes any goods at any stage,
process or progress of manufacture or of any part or branch of
manufacture, either mixed or separate, or any materials whatever
plainly intended for the composing or manufacturing of any goods
before such goods or materials are completed or finished for the
purpose of wear, consumption or use.

(2) In this Act, unless the contrary intention appears

(a)a reference to any other enactment shall be construed as a
reference to that enactment as amended by any subsequent enactment
for the time being in force;

(b)a reference to an enactment of the Parliament of the United
Kingdom shall be construed as a reference to that enactment as it
has effect in Northern Ireland for the time being;

(c)a reference by number to a section is a reference to the
section of this Act bearing that number;

(d)a reference by number to a Schedule is a reference to the
Schedule to this Act bearing that number;

(e)a reference by number to a sub-section is a reference to the
sub-section bearing that number of the section in which the
reference occurs.

PAWNBROKERS ACT (NORTHERN IRELAND) 1954 - SECT 2
Transactions to which this Act applies.

2. This Act shall apply to every transaction in respect of a
pledge whereon a loan or advance not exceeding fifty pounds is made
by a pawnbroker to a pawner but shall not apply nor have effect
in relation to any other transaction.

PAWNBROKERS ACT (NORTHERN IRELAND) 1954 - SECT 3
Servants, agents and representatives of pawnbrokers.

3.(1) Anything authorised by this Act to be done by a pawnbroker
may be done by his servant or agent.

(2) For the purposes of this Act anything done or omitted by a
servant or agent of a pawnbroker in the course of the business of
the pawnbroker shall be deemed to be done or as the case may be
omitted by the pawnbroker.

(3) The provisions of this Act relating to pawnbrokers shall have
effect in relation to executors and administrators of deceased
pawnbrokers, so, however, that such an executor or administrator
shall not be personally liable to any penalty or forfeiture not
incurred by his own act or default.

PAWNBROKERS ACT (NORTHERN IRELAND) 1954 - SECT 4
Transmission of rights, etc., of pawners.

4.(1) Any rights, powers, privileges and benefits by this Act
reserved to or conferred on pawners shall be deemed to be reserved
to and conferred on the assignees of pawners and the executors and
administrators of deceased pawners.

(2) Any person representing himself to a pawnbroker to be the
assignee, executor or administrator of a pawner shall, if so
required by the pawnbroker, produce to him the instrument under
which he claims.

Ss.5-9 rep. by 1974 c.39 s.192(3)(b) sch.5 Pt.II

PAWNBROKERS ACT (NORTHERN IRELAND) 1954 - SECT 10
Pawnbrokers to keep records, etc.

10.(1) Every pawnbroker shall in the course of his business

(a)keep a book or record in the form specified in the First
Schedule or a form to the like effect; and

(b)use as occasion requires the several documents in the Second
Schedule in the forms therein specified or forms to the like
effect.

(2) Every pawnbroker shall in the course of his business clearly
and legibly enter, as occasion requires, in any book, record or
document kept or used by him under this section, such particulars
as are required by the said Schedules respectively; and it shall be
the duty of a pawnbroker to make all enquiries necessary for the
purpose of complying with this sub-section.

(3) A pawnbroker who fails to comply with any of the provisions of
this section shall be guilty of an offence against this Act.

S.11 rep. by 1974 c.39 s.192(3)(b) sch.5 Pt.II

Pawnbroker to issue pawn-tickets.

PAWNBROKERS ACT (NORTHERN IRELAND) 1954 - SECT 12

12.(1) A pawnbroker shall on taking a pledge in pawn give to the
pawner a pawn-ticket, and shall not take a pledge in pawn unless
the pawner takes a pawn-ticket.

(2) There shall be set forth on pawn-tickets such particulars as
are required by Part I of the Second Schedule.

(3) A pawnbroker who fails to comply with any of the requirements
of this section shall be guilty of an offence against this Act.

PAWNBROKERS ACT (NORTHERN IRELAND) 1954 - SECT 13
Loans to be in current money.

13.(1) Every sum paid, lent or advanced in respect of goods or
chattels taken in pawn shall be paid in good and lawful current
money and not otherwise, and no sum shall be made up or completed
by the inclusion of any other kind of value, benefit or payment.

(2) Where a pawnbroker acts in contravention of sub-section (1) a
court of summary jurisdiction, on the application of the pawner,

(a)shall order the sum properly due to be paid to him in good and
lawful current money;

(b)may in its discretion order the pawner to repay or return the
whole or any part of the other kind of value, benefit or payment
given in contravention of sub-section (1).

PAWNBROKERS ACT (NORTHERN IRELAND) 1954 - SECT 14
Division of loan prohibited.

14. A pawnbroker who divides into smaller sums the advance or loan
sought by any borrower shall be guilty of an offence against this
Act.

PAWNBROKERS ACT (NORTHERN IRELAND) 1954 - SECT 15
Lawful profits and charges.

15.(1) A pawnbroker may take a profit on the loan on a pledge at
a rate not exceeding that specified in Part I of the Third
Schedule.

(2) A pawnbroker may demand and take the charges specified in Parts
II and III of the Third Schedule.

(3) A pawnbroker shall not demand or take any profit in respect of
a loan on a pledge, or demand or take any charge or sum whatever
otherwise than those permitted by sub-sections (1) and (2).

(4) A pawnbroker shall, if so required at the time of the
redemption of any pledge, give a receipt for the amount of the
loan and profit paid to him, which receipt shall be in the form,
and shall set forth the particulars, specified in the Second
Schedule or in a form to the like effect.

(5) A pawnbroker who fails to comply with any of the requirements
of this section shall be guilty of an offence against this Act.

PAWNBROKERS ACT (NORTHERN IRELAND) 1954 - SECT 16
Redemption periods, etc.

16.(1) Subject to the provisions of sub-sections (2) and (3) the
redemption period shall be

(a)for a pledge pawned for a sum less than three pounds, six
months;

(b)for a pledge pawned for a sum of three pounds or more, but
less than five pounds, nine months; and

(c)for a pledge pawned for a sum of five pounds or more, one
year.

(2) The redemption period for any pledge made up wholly or partly
of gold, silver or other precious metal, or of any precious or
semi-precious stone or stones, shall be one year.

(3) To each of the redemption periods provided by this section
there shall be added seven days (which may be known as days of
grace) during which a pledge may not lawfully be sold or disposed
of by a pawnbroker; and the days of grace shall be deemed to be
part of each redemption period.

PAWNBROKERS ACT (NORTHERN IRELAND) 1954 - SECT 17
Unsold pledges to continue redeemable.

17.(1) After the expiry of any relevant period fixed by section
sixteen, a pledge not sold or disposed of by a pawnbroker may be
redeemed at any time.

(2) A pawnbroker who in order to deprive a pawner of his right
under sub-section (1) falsely states that a pledge has been sold or
disposed of, shall be guilty of an offence against this Act.

PAWNBROKERS ACT (NORTHERN IRELAND) 1954 - SECT 18
Sale of pledges.

18.(1) It shall be lawful for a pawnbroker to sell or dispose or
any unredeemed pledge at any time after the expiration of the
relevant redemption period.

(2) A pawnbroker or the servant or agent of a pawnbroker who
purchases any pledge except at a public auction shall be guilty of
an offence against this Act.

Holder of pawn-ticket entitled to redeem.

PAWNBROKERS ACT (NORTHERN IRELAND) 1954 - SECT 19

19.(1) The holder for the time being of a pawn-ticket shall, as
between the pawner and the pawnbroker, be presumed to be the person
entitled to redeem the pledge, and accordingly, subject to the
provisions of this Act, a pawnbroker shall on delivery to him of
the pawn-ticket and on payment of the loan and profit, and any
other charges payable under this Act, deliver the pledge to such
holder.

(2) A pawnbroker shall not be bound to deliver up a pledge unless
the provisions of sub-section (1) are complied with.

PAWNBROKERS ACT (NORTHERN IRELAND) 1954 - SECT 20
Liability of pawnbroker in case of fire.

20.(1) Where a pledge is destroyed or damaged by or in consequence
of fire the pawnbroker shall be liable, on application made within
the appropriate redemption period, to pay to the pawner the value
of the pledge, after deducting the amount of the loan and profit,
such value to be the amount of the loan and profit, and fifty per
cent. of the amount of the loan.

(2) A pawnbroker shall have an insurable interest in a pledge to
the extent of its value computed in accordance with sub-section (1).

PAWNBROKERS ACT (NORTHERN IRELAND) 1954 - SECT 21
Compensation for depreciation of pledge.

21. A court of summary jurisdiction, if satisfied, on the
application of a person entitled and offering to redeem a pledge,
that by reason of any wilful act or any default of the pawnbroker
the pledge is of less value than it was at the time of the
pawning thereof, may if it thinks fit award to the owner of the
pledge reasonable compensation in respect of the damage; and the
amount so awarded shall be deducted from the sum payable to the
pawnbroker, or as the case may require, shall be paid by the
pawnbroker, in such manner as the court may direct.

PAWNBROKERS ACT (NORTHERN IRELAND) 1954 - SECT 22
Protection of owners and pawners not having pawn-tickets.

22.(1) Any person

(a)claiming to be the owner of a pledge but not holding the
pawn-ticket; or

(b)claiming to be entitled to hold a pawn-ticket but alleging that
it has been lost, mislaid, destroyed or stolen, or taken from him
by fraud;

(2) When and so soon as a person within three days from the
delivery to him of a form under sub-section (1) delivers to the
pawnbroker the appropriate declaration duly made by him and by a
person identifying him before a resident magistrate or justice of
the peace or commissioner for oaths, the first mentioned person
shall as between himself and the pawnbroker have the same rights
and remedies as if he had produced the pawn-ticket.

(3) A pawnbroker who has delivered a form to any person in
accordance with sub-section (1) is hereby indemnified

(a)for refusing to deliver the pledge to any other person until
after the expiration of the three days referred to in sub-section
(2);

(b)unless he has actual or constructive notice that a declaration
under sub-section (2) is false in any material particular, for
delivering up the pledge or otherwise acting in conformity with the
declaration.

PAWNBROKERS ACT (NORTHERN IRELAND) 1954 - SECT 23
Delivery to owner of property unlawfully pawned.

23. Where

(a)any person is convicted before any court under this Act of
knowingly and wrongfully pawning with a pawnbroker any goods or
chattels belonging to another person; or

(b)any person is convicted of stealing or fraudulently obtaining any
goods or chattels, and it appears to the court that those goods or
chattels have been pawned with a pawnbroker; or

(c)it appears to a court in the course of any proceedings that any
goods or chattels before it have been unlawfully pawned with a
pawnbroker;

Summary order for delivery of pledge.

PAWNBROKERS ACT (NORTHERN IRELAND) 1954 - SECT 24

24.(1) A pawnbroker who without reasonable cause refuses or neglects
to deliver a pledge to a person entitled thereto under this Act,
shall be guilty of an offence against this Act.

(2) On a prosecution under this section a court of summary
jurisdiction may if it thinks fit, with or without imposing a
penalty, order

(a)the delivery of the pledge to the person entitled thereto;

(b)the payment by that person of the whole or part of the amount
of the loan and profit; or

(c)both such delivery and such payment.

(3) In a prosecution under this section the burden of proof shall
lie on the defendant.

Prohibition of purchasing pledges, taking pledges from children, etc.

PAWNBROKERS ACT (NORTHERN IRELAND) 1954 - SECT 25

25. Any pawnbroker who

(a)takes anything in pawn from any person apparently under the age
of sixteen whether offered by that person on his own behalf or on
behalf of another person, or from any person apparently intoxicated,
or from a person known to him to be a habitual drunkard;

Para.(b) rep. by 1968 c.27 (NI) s.36 sch.5

(c)purchases or takes in pawn or exchange a pawn-ticket issued by
himself or another pawnbroker;

(d)employs or permits any servant, apprentice or other person under
the age of sixteen to take pledges in pawn;

(e)permits any pledge in pawn with him to be redeemed with a view
to his purchasing it;

(f)makes any contract or agreement with any person pawning or
offering to pawn anything, or with the owner thereof, for the
purchase, sale or disposition thereof within the redemption period;

(g)sells or otherwise disposes of any pledge pawned with him except
in accordance with the provisions of this Act;

(h)takes any pledge in pawn from any person except between the
hours of nine in the morning and seven in the evening; or

(i)carries on the business of pawnbroker on a Sunday or on
Christmas Day;

Unlawful pawning of property of another.

PAWNBROKERS ACT (NORTHERN IRELAND) 1954 - SECT 26

26.(1) Any person who knowingly and wrongfully pawns with a
pawnbroker anything belonging to another person shall be liable on
summary conviction to a fine not exceeding fifty pounds or to
imprisonment for a term not exceeding six months or to both such
fine and such imprisonment.

(2) In addition to any fine imposed on any person under sub-section
(1), the court may order that person to pay to the owner by way
of compensation any sum not exceeding the full value of the pledge
as determined by the court, which sum shall be recoverable as a
penal sum adjudged to be paid upon summary conviction.

PAWNBROKERS ACT (NORTHERN IRELAND) 1954 - SECT 27
Attempted pawning in suspicious circumstances, etc.

27. Any person who

(a)offers to a pawnbroker anything by way of pawn being unable or
refusing to give a satisfactory account of the means by which that
thing came into his posession;

(b)wilfully gives false information to a pawnbroker about the
ownership of anything offered by him by way of pawn to the
pawnbroker, or about his name and address, or the name and address
of the owner of that thing; or

(c)not being entitled, or not having any bona fide claim of right,
to redeem a pledge, redeems or attempts to redeem or procures any
other person to redeem or attempt to redeem such pledge;

Duty of pawnbroker on offer of pledge, etc., in suspicious
circumstances.

PAWNBROKERS ACT (NORTHERN IRELAND) 1954 - SECT 28

28.(1) A pawnbroker, where it appears to him that

(a)the circumstances in which a person offers anything to him by
way of pawn are suspicious; or

(b)a person attempting to redeem a pledge has no right nor bona
fide claim of right to redeem such pledge;

(2) If any such person being so required is unable or refuses to
give to the pawnbroker a satisfactory account of himself or of the
means by which the thing or the pawn-ticket came into his
possession, or gives any information about such thing or pawn-ticket,
or his name or address, or the name or address of the owner of
the thing, which appears to the pawnbroker to be false, or if the
pawnbroker has any other reason to suspect that the thing or
pawn-ticket has been stolen or otherwise unlawfully or wrongfully
obtained, the pawnbroker shall forthwith report the circumstances at
a police station, and shall take all reasonable steps to detain
such person and to deliver him as soon as practicable into the
custody of a constable to be dealt with according to law.

(3) A pawnbroker who fails to comply with any of the provisions of
this section shall be guilty of an offence against this Act.

PAWNBROKERS ACT (NORTHERN IRELAND) 1954 - SECT 29
Prohibition on taking in pawn linen, wearing apparel, etc.

29.(1) Any pawnbroker who knowingly takes in pawn without the
authority or consent of the owner any linen or wearing apparel or
unfinished goods or materials entrusted to any person to wash,
scour, iron, mend, manufacture, work up, finish or make up, shall
be liable on summary conviction to a fine not exceeding one hundred
pounds or to imprisonment for a term not exceeding twelve months or
to both such fine and such imprisonment.

(2) A pawnbroker convicted under sub-section (1) shall restore the
pledge to the owner thereof in accordance with such directions as
may be given by the court.

PAWNBROKERS ACT (NORTHERN IRELAND) 1954 - SECT 30
Search warrants in respect of things unlawfully pawned.

30.(1) Where a resident magistrate or justice of the peace is
satisfied on oath that there are reasonable grounds for believing
that a pawnbroker is guilty of an offence under section twenty-eight
or section twenty-nine, or that a pawnbroker is in possession of
anything unlawfully pawned, he may issue a warrant authorising the
search of the shop, dwelling-house or other premises owned or
occupied by that pawnbroker.

(2) If such pawnbroker refuses to open the shop, dwelling-house or
premises or to permit the shop, dwelling-house or premises to be
searched at any reasonable time, the constable authorised by the
warrant to make the search may break open and search the shop,
dwelling-house or premises.

(3) Anything found in such shop, dwelling-house or premises which
has been unlawfully pawned shall be restored to the person whose
ownership thereof is established to the satisfaction of a resident
magistrate or justice of the peace.

(4) Any pawnbroker or other person who obstructs or impedes, or
assists another person to obstruct or impede a constable in his
search under this section shall be guilty of an offence against
this Act.

(5) A constable shall not be liable in respect of anything done by
him in good faith in the execution of this section.

PAWNBROKERS ACT (NORTHERN IRELAND) 1954 - SECT 31
Frivolous complaints.

31.(1) A court of summary jurisdiction, where it appears to it that
any complaint in respect of an offence against this Act has been
brought before it on insufficient grounds, may order the complainant
to pay to the defendant such sum not exceeding ten pounds as the
court may think proper by way of compensation for loss of time and
expense.

(2) A sum ordered to be paid under sub-section (1) shall be
recoverable as a penal sum adjudged to be paid on summary
conviction.

PAWNBROKERS ACT (NORTHERN IRELAND) 1954 - SECT 32
Detention of persons presenting forged pawn-tickets.

32.(1) If any person utters, produces, shows or offers to a
pawnbroker a pawn-ticket which the pawnbroker reasonably suspects to
have been counterfeited, forged or altered, the pawnbroker shall take
all reasonable steps to detain that person and to deliver him as
soon as practicable into the custody of a constable to be dealt
with according to law.

(2) A pawnbroker who fails to comply with sub-section (1) shall be
guilty of an offence against this Act.

PAWNBROKERS ACT (NORTHERN IRELAND) 1954 - SECT 33
Production of books, etc.

33.(1) Any books, records or documents kept by a pawnbroker under
this Act shall be produced by him for examination

(a)at any time by any court which so orders; or

(b)on demand at any reasonable time by an officer, head constable
or sergeant of the Royal Ulster Constabulary.

(2) Any court may at any time

(a)order or summon a pawnbroker to attend and produce to the court
any books, records or documents kept by him under this Act; or

(b)order or authorise a constable to search for and examine, and if
need be to take a copy of or extract from, any such book, record
or document.

(3) A pawnbroker who fails to comply with any of the requirements
of this section shall be guilty of an offence against this Act.

PAWNBROKERS ACT (NORTHERN IRELAND) 1954 - SECT 34
Notification by police of lost and stolen property.

34.(1) It shall be the duty of every district inspector of the
Royal Ulster Constabulary forthwith to notify to all pawnbrokers
within his district full particulars of any property lost, stolen or
otherwise fraudulently obtained or disposed of.

(2) A pawnbroker to whom any property answering to the description
of anything so notified as aforesaid is thereafter offered or shown,
or who has any such property in his possession, shall without delay
inform the nearest police station, and shall take all reasonable
steps to detain any person offering or showing such property and to
deliver him as soon as practicable into the custody of a constable
to be dealt with according to law.

(3) A pawnbroker who fails to comply with any of the requirements
of this section shall be guilty of an offence against this Act.

PAWNBROKERS ACT (NORTHERN IRELAND) 1954 - SECT 35
Provisions relating to detention of persons by pawnbrokers.

35.(1) It shall be a defence to any proceedings, whether civil or
criminal, against a pawnbroker, or the servant or agent of a
pawnbroker, in respect of anything done by him in the course of
detaining, or attempting to detain, any person in accordance with
any requirement of this Act to prove that anything so done was
done upon resonable grounds and in the bona fide belief that such
detention was necessary under this Act.

(2) Any person detained by a pawnbroker, or the servant or agent
of a pawnbroker, in compliance with any provision of this Act who
escapes or attempts to escape from such detention shall be guilty
of an offence against this Act.

PAWNBROKERS ACT (NORTHERN IRELAND) 1954 - SECT 36
Penalties for offences.

36.(1) A person guilty of an offence against this Act in respect
of which a penalty is not expressly provided shall be liable on
summary conviction

(a)in respect of a first offence, to a fine not exceeding twenty
pounds;

(b)in respect of a second or subsequent conviction of any offence
against this Act, to a fine not exceeding fifty pounds or to
imprisonment for a term not exceeding three months or to both such
fine and such imprisonment;

(c)in respect of a continuing offence, to a further fine not
exceeding two pounds for every day during which the offence is
continued.

(2) A conviction for an offence under any enactment repealed by
this Act shall for the purposes of this Act be treated as a
conviction for an offence against this Act.

PAWNBROKERS ACT (NORTHERN IRELAND) 1954 - SECT 37
Contracts not avoided by convictions.

37.(1) Subject to the provisions of this Act, where a pawnbroker is
convicted of an offence against this Act (not being an offence
against the provisions of this Act relating to licences) any
contract made by him with a pawner or otherwise in relation to his
business shall not be void by reason only of such conviction, nor
by reason only thereof shall he lose his lien on or right to the
pledge or to the loan and profit.

(2) Nothing in this section shall restrict the operation of any
provision of this Act providing for the delivery, by order of a
court or resident magistrate or justice of the peace, to the lawful
owner of any goods or chattels unlawfully pawned.

S.38 rep. by SLR 1973

PAWNBROKERS ACT (NORTHERN IRELAND) 1954 - SECT 39
Short title.

39.(1) This Act may be cited as the Pawnbrokers Act (Northern
Ireland), 1954.

Subs.(2) rep. by SLR 1973

2. 3. 4. 5.

All entries respecting each pledge shall be made on the day of
pawning thereof, or within four hours after the end of that day.

(The appropriate particulars are required to be entered by the
pawnbroker in the respective blank spaces).

The pledge may be sold by the pawnbroker and shall thereby be
forfeited, if it is not redeemed before or within the seven days
of grace allowed after [final date allowed for redemption] .Part II
spent

On any loan made under this Act, in respect of each shilling lent
for every calendar month during which the pledge remains in pawn

In the computation of the profit as in this Part provided, part of
a shilling shall be treated as a shilling and part of a month as
a month.

In respect of each pawn-ticket, two pence.

In respect of a form of declaration, two pence.

TAKE NOTICE if this declaration is false the person making it is
punishable as for perjury.

Unless this printed form is taken before a resident magistrate or
justice of the peace or commissioner for oaths and declared to and
signed and delivered back to the pawnbroker not later than the

I, A.B., of < in pursuance of the PawnbrokersAct (Northern Ireland), 1954, do solemnly and sincerely declare that the article (or articles) described below is (or are) my property, and that I believe it is (they are) pledged at the shop of

The article (or articles) above referred to is (or are) the
following:

And I, C.D., of < in pursuance of the said Actdo solemnly and sincerely declare that I know the person now making the foregoing declaration to be A.B., of

Declared before me this < day of19<<(Signed)

TAKE NOTICE if this declaration is false the person making it is
punishable as for perjury.

Unless this printed form is taken before a resident magistrate or
justice of the peace or commissioner for oaths and declared to and
signed and delivered back to the pawnbroker not later than the

I, A.B., of <, in pursuance of the Pawn-brokers Act (Northern Ireland), 1954, do solemnly and sincerely declare that <<<<<<<<<<<< pledged at the shop of <<<<<<<<<<<< pawnbroker, the article (or articles) described below being property, and received a pawn-ticket for the same, which has since been;

The article (or articles) above referred to is (or are) the
following:

And I, C.D., of <, in pursuance of the said Act do solemnly and sincerely declare that I know the person now making the foregoing declaration to be A.B., of

Declared before me this < day of 19<


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