Schedule B.

Form of Bottle License.

Whereas A. B. of____________hath deposited in tins office a certificate dated the day of____________18_________ authorising the issue to the said A. B. of a "Bottle License": And whereas the said A. B. hath paid into my office the sum of ten pounds sterling, as the Fee on this License, pursuant to the provisions of the "Licensing Ordinance 1865 Now I, the Provincial Treasurer, by virtue of the powers vested in me by this Ordinance, do hereby license the said A. B. to sell any Fermented and Spirituous Liquors, in bottles corked and sealed, capsuled or wired, of sizes not less than those of which six or twelve are usually reckoned to the gallon (not to be drunk in or upon the house or store and premises licensed) in his house (or store) situate ___________ in the Province of Otago aforesaid, and on the premises thereunto appertaining, but not elsewhere. And this License shall commence 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 ______________________