(Reverse of authorization)
Details of purchases made by the holder of the authorization
Total quantity of wine and/or liquor allowed to be purchased during the period of the authorization: Quart bottles.
| (1) Date of purchase | (2) Quantity purchased | (3) Progressive total of the quantity of wine and/or liquor purchased up to date from the date of commencement of the authorization | (4) Quantity of wine and/or liquor which can be purchased during the remaining period of the authorisation | (5) Name of the licensed manufactory or Government or licensed depot from where purchased | (6) Signature of the licensed manufacturer or depot-keeper or the Officer in charge of the Government Depot |
|---|---|---|---|---|---|
| Wine Liquor | |||||
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