Certificate to Authorize the issue of a Billiard Table License.

We the undersigned being the majority of the licensing magistrates assembled at the licensing meeting holden at on the____day of [or I the undersigned being a licensing stipendiary magistrate at the holding of the court of petty sessions at on the____day of____] do hereby authorize the issue to____of of a billiard table license for Given under hand the____day of One thousand eight hundred and seventy-