Registration of Clubs (Ireland) Act, 1904

SCHEDULES.

FIRST SCHEDULE.

Form of Certificate to accompany Application by Club for Registration or Renewal.

Section 2 .

We, Justices of the Peace for the County [or County Borough] of

and I,          owner of the premises occupied [or to be occupied] by the club hereinafter mentioned, hereby certify that to the best of our knowledge and belief the          club designated in the accompanying application is to be [or, in the case of an application by an existing club, has been and is to be] conducted as a bonâ fide club, and not mainly for the supply of exciseable liquor.

[Signature, date and address of each person certifying to be here inserted.]