FORM A

794	Bombay Prohibition Act, 1949 [1949 : Bom. XXV
the date of such suspension, cancellation or expiration.The stock of liquor so
surrendered shall be sold by the Collector and the proceeds of the sale shall after
deducting the expenses and any sum due to the State Government be returned to the
licensee.
Place :
Dated :                                                                        Collector of .............................
Seal of the
Collector
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FORM ‘A’
[See rule 87 (6)]
Cash Memo
No.	Date
Name and address of the licenseeNo. of the licence in Form (F. L. XII)
Name and address of the person to whom Name and address of the person to whom
prescribed.	delivered.
Name and address of the Registered
Medical practitioner by whom prescribed.
Prescription	Foreign liquor prescribed
No. Date Kind Quantity Amount received
(1) (2) (3) (4) (5)
Rs. P. S.
Signature of the licensee or his
authorised agent or servant.