FORM D.S.XIX
[See rule 18(4)]
D. S. I Licence No ...........................
Name of the Licensee ..........................
Period of the Licence .........................
Monthly return of stock account of readied spirit intended for denaturation for the month of .................. 19 ............ Warehouse.
| On hand and received | Delivered | ||
|---|---|---|---|
| Amount received | Received | Increase from | |
| 10 | 12 | 13 | 14 |
| Delivered | |||
| Deficiencies allowed | |||
| P.L. | P.L. | P.L. | |
| Delivered | |||
| Excess deficiencies charged with duty | |||
| P.L. | P.L. | P.L. | |
| 15 | 16 | 17 | |
Date. ........................... Signature of licensee ...........................
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