FORM C.L.XV—contd
| Country liquor supplied to retail sale shop licensees in bottles and other receptacles | ||||
|---|---|---|---|---|
| Indent No. and date received from the licensed retail shop | Transport Pass No. and date | Licence No. of the shop and name of shop-keeper | Country liquor supplied to retail sale shop licensees in bottles and other receptacles | |
| 750 ml. (22) | 375 ml. (23) | |||
| 180 ml. (24) | Total quantity in bottles (25) | |||
| 200 B.L. (26) | -B.L. (27) | |||
| Total B.L. (28 + 31) (28) | ||||
| Held in balances in bottles and in other receptacles | ||||||||
|---|---|---|---|---|---|---|---|---|
| 750 ml. (33) | 375 ml. (34) | 180 ml. (35) | Total quantity in bottles (36) | 200 B.L. (37) | - B.L. (38) | Total quantity in receptacles (39) | Total (36 + 39) (40) | Remarks, if any, and signature of the licensee or his authorised agent (41) |
- Here mention the receptacles of any other capacity allowed to be filled in by the Commissioner.]
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