The Pamphlet Collection of Sir Robert Stout: Volume 36
The Eighth Schedule
The Eighth Schedule.
I the undersigned being a licensing stipendiary magistrate being satisfied of the facts and matters hereinafter certified do hereby certify that a____license was on the____day of____issued to of in respect of the house known as and situate____and that such license is lost or destroyed and has not been forfeited or transferred.
Dated the____day of____One thousand eight hundred and seventy-