Schedule R.

Form of Endorsement of a Temporary Transfer of License to a Purchaser or Assignee of Licensed Premises.

I, (or we as the case may be) Resident Magistrate at____________(or two of Her Majesty's Justices of the Peace having jurisdiction in the Licensing District of____________)do hereby upon the application of the within-named A. B., it having been proved to (____________) that the necessary notice has been given by the said A. B., and the said A. B., having paid to the Provincial Treasurer the Fee of £1, transfer the License granted to the said A. B. (state the nature of the Licence) for the house and premises known as____________situate at____________to E. F, the purchaser (or assignee of the lease of) the said house and premises, until the next Quarterly Licensing Meeting to be holden for this district.

Given under my (or our) hand (or hands) at____________this____________day of____________one thousand eight hundred and____________