Schedule O.

Form of Application for Transfer of License.

To the Worshipful the Justices of the Peace acting in and for the Licensing District ____________ of ____________ in the Province of Otago.

I, A. B., of (here state the place of residence and house licensed, the sign if any)being the holder of a (state nature of License) License under "Licensing Ordinance 1865," in respect of the said house and premises do hereby give notice that it is my page 30 intention to apply at the next Quarterly Licensing Meeting, to be holden in and for the said district, to the Justices to transfer the said License from myself to C. D. ____________ my appointee.

Signed this____________day of____________

A. B.