Form, printed with ms additions. Form 1, to be completed by lessors, where there is dispute over adjustment of rent on account of poor rate. Adjustment of Rent under Sec. 54 of Local Government (Ireland) Act, 1898; occupier Thomas W. Westropp Bennett, Ballyteige Upper. 15th Oct. 1900. Giving details of holding, signed by Samuel R.C. Hemphill, land agent for lessors. Printed in black with blue lines on blue paper, on one side only, by B & N. Ltd. Folded in four.