Schedule A.

Form of General License.

Whereas A.B. ________ of _________ hath deposited in this office a certificate dated the __________ day of ________ 18 _________ authorising the issue to the said A. B. of a License for the house known (or to be known) by the sign of situate at in the Province of Otago, in the Colony of New Zealand:

And whereas the said A. B. hath paid into my office the sum of twenty pounds sterling as the Fee on such License pursuant to the provisions of the "Licensing Ordinance 1865: "Now I, the Provincial Treasurer by virtue of the powers vested in me by the said Ordinance, do hereby License the said A. B. to sell any fermented or spirituous liquors ill any quantity in the house aforesaid and in the appurtenances thereunto belonging, but not elsewhere. And this License shall commence page 26 on the_______day of________and shall continue in force until the thirty-first day of December next, both days inclusive.

Given under my hand at _______ this__________ day of _________ one thousand eight hundred and ________________