Licensing Act (Ireland) 1874

SCHEDULE A.

Sect. 15 .

Form of Notice.

To the Clerk of the Peace for the county [or city or town] of

Take notice, I have obtained a [license, early-closing license, or six-day license, as the case may be] to sell spirits, beer, and cider by retail up to the        day of              18    , and I require you to enter my name and the description of my house in the Register of Licenses as follows :—

Christian name of trader.

Surname of same.

Place of abode of same.

Description or sign of house and premises.

Name of townland [or in cities, towns, or villages, name of street and number therein].

Petty sessions district where house situate.

Christian name of owner of house.

Surname of same.

Address of same.

Dated this            day of            18      .

Trader's name.