Sec. 57 (10).

Sec. 59.

Sec. 9.

Seventh Schedule.

The Licensing Act, 1911.

CONFIRMATION ON ENTRY BY SUCCESSOR OR OWNER.

Whereas A. B. has, pursuant to Section 57 of the Licensing Act, 1911, entered into the within premises as successor [or as the agent of the successor] of the within named C.D. [or as being the person, or the agent of the person, entitled to the possession such premises] and the within License [or Certificate] has become vested in the said A.B. Now I [or We] A.S.R. [or J.K. and M.N.] Chairman [or two members of the Licensing Court for the District of X. do hereby confirm the said License [or Certificate) unto the said A.B. and do authorise him to hold and exercise the same [or the License therein mentioned which I or We authorise the receiver of revenue to issue to and in the name of the said A. B.] up to the end of the within-mentioned term of such Licens [or till after the holding of the Licensing Court of the said District to be held in the month of next, to which time I [or We] do hereby extend the said License]. 19.

Dated the

day of

house and premises known as

PREMISES.

the holder of a [state the nature of the license] license for th

situated at

do hereby give notice that it is my intention to apply to the Licensing Court to it

held at

on •

to remove the license [descr

the premises to which it is proposed to remove the license].
Dated the

day of

Ninth Schedule.

The Licensing Act, 1911.`

INDORSEMENT ON REMOVAL OF LICENSE.

The Licensing Court for the

Qua erly Licensing Sitting held at

District,
on the

One thousand nine hundred and

of

at the

being satis the

that the requisite notice of application for removal was duly served and publish

premises described in the within license, and that the same shall hereafter apply to

Tenth Schedule.

The Licensing Act, 1911.

NOTICE OF APPLICATION FOR PROVISIONAL CERTIFICATE.

To the Licensing Court for the
I.

District.

[state name, residence, and occupation], hereby give notice that I intend to apply, at the next quarterly sitting of the Licensing Court for this District, for a Provisional Certificate for the premises belonging to me for rented by me from 1, and situated at

of within the said district. The said premises are now to be erected [or, are in course of erection, or are now being altered, or are now nearly complete], and will, when finished, be in all respects in accordance with the requirements of the Licensing Act, 1911. Dated this

day of

19.

(Signature of applicant.)

District, at the quarterly sitting
day of
19, hereby
situate at

and

certify that the house and premises of
now in process of erection [or about to be erected], in accordance with the plans and
specifications exhibited by the said
and signed by us, will be a fit and proper
place for business to be carried on under a Publican's General License and upon applica-
tion being duly made by a fit and proper person for the issue of a license in respect of
the said house within twelve months from the date hereof, such application will be granted
upon proof being given that the said house and premises have been erected [or completed]
in accordance with such plans and specifications, and that the following conditions have
been complied with. This certificate is granted subject to the following conditions:
(Here set out the conditions, if any.)
day of

Dated this

19.

Chairman.

Twelfth Schedule.

The Licensing Act, 1911.

CERTIFICATE FOR THE ISSUE OF A LICENSE.

Receiver of Revenue for the said District to issue to A.B. of
state description of license] license for [describe premises for which license granted, or, in
case of a packet license, the vessel] for the year ending the 31st day of December, 19

Sec. 61.

Sec. 61.

Sec. 68.

Sec. 68.

Sec. 71.

Sec. 87.

No. 39 of 1922,

sec. 131.

Sec. 98.

No. 39 of 1922,

sec. 131.

of....

Licensing District.

You are hereby summoned to appear before the Licenses Reduction Board at

the hour of...

premises known as....

.on the....

...o'clock in the.

not be deprived of a license.

Given under my hand this..

..day of.........

19....... at

..noon to show cause why the licensed ..should ...and situated at.........

Indicate your vote by placing a cross thus X in one of the above squares.

Indicate your vote by placing a cross thus X, in one of the squares.

the said State

of a

complaint was made before the undersigned, of His Majesty's Justices of the Peace for the said State (or for the Magisterial District of ], that being the holder license, did [here set out offence]. And the said having been convicted of the said offence, and having within a period of twelve months been convicted two several times of offences referred to in Section 175 of the Licensing Act, 1911, namely [set out particulars of convictions. Now, therefore, we do hereby declare that the said license of the said

is forfeited.

day of

Be it remembered that on the

in the said State, complaint was made before the Licensing Court of the
Licensing District, that A.B., being the holder of a
premises situated at

19, at

license for the

[here set out the acts which have caused the forfeiture, and the substance of the said 'complaint having been proved to the satis faction of the Court, the said Court therefore declares the said license forfeited.

Dated this

[SEAL.]

Sec. 175

Sec. 177.

Sec. 190.

Sec. 191.

Sec. 192.

Sec. 196.

Twentieth Schedule.

The Licensing Act, 1911.

NOTICE OF APPLICATION FOR THE REGISTRATION OF CLUB.

To the Licensing Court of the

I,

known as the

of

Licensing District. being the secretary of the Club Club, hereby give notice that I intend to apply at the next quarterly sitting of the Licensing Court for a certificate of the registration of the said Club.

I,

under the said Act in

A CLUB.

Secretary of the

Licensing District.

Club, duly registered hereby give notice that I intend to apply at the next quarterly sitting of the said Licensing Court for a renewal of such registra tion.

in the State of Western Australia, hereby certify that

I have this day inspected the premises in [describe the situation] and known [or intended
to be known] as
notice of application for a certificate for resignation
for which [or a renewal of a certificate of registration for which or of removal to which
under the Licensing Act, 1911, has been given. And I hereby certify that the said pre
mises are suitable for the purposes of a club.

I also certify that I have inspected the certified copy of the register of members of the said club, and having made proper inquiries with respect to the particulars con tained therein, find that such particulars are correct.

I further certify that after proper inquiries I find that the provisions of the said
Act with respect to such club are fully complied with.
As witness my hand this

Licensing District. Secretary [or as the case may be] of the duly registered in premises situated at in the said district, hereby give notice that I intend to apply at the next quarterly sitting of the said Licensing Court for a certificate of removal, so that it may apply to the premises [here describe the situation of the new premises].