Schedule T.

Form of Endorsement of change of house and premises on License.

Memorandum:____________ do hereby declare that A. B. having paid the fee of one pound to the Provincial Treasurer the within license shall henceforth cease to apply to the house and premises therein described and shall apply instead thereof to the house and premises situate (describe new premises).

(Signature of two Justices of the Peace or Resident Magistrate)____________