Schedule K.

Form of Certificate by Justices to authorise granting a____________License.

At the Quarterly Licensing Meeting held at____________on the____________day of____________18, for the Licensing District of____________pursuant to the "Licensing Ordinance 1865," we, being the majority of the Justices assembled at such meeting, do, in virtue of the power vested in us, authorise the Provincial Treasurer, or other proper officer, to issue to A. B., of____________, the License in the said Ordinance called

Given under our hands at the____________, on the ____________