FORM F. L. X-D

FORM F.L. X-D

(See rule 70-F)

No.

Shri/Smt./Kum. ...................................... age ........................ residing at ......................................................................... is hereby permitted to purchase, possess, transport, use and consume mild liquor within the State of Maharashtra, subject to the provisions of the Bombay Prohibition Act, 1949, and the rules, regulations and orders made hereunder, during the period commencing on the date on which this permit is granted and ending on ..........................................

Place :

Date : ........................ Signature of Officer.

Seal

Specimen signature or thumb impression of the permit holder.

(To be filled in and handed over to the Officer issuing permit for grant of permit for subsequent period.)

I declare that I continue to require mild liquor for preservation and maintenance of my health.

Place :

Date : ........................ Signature of thumb impression of permit-holder.

1 Ins. by G. N. of 8-8-1979.