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.
Dated: Collector of
Seal of the Collector
[See rule 87 (6)]
Cash Memo
| No. | Date |
Name and address of the licensee
No. of the licence in Form (F. L. XII)
Name and address of the person to whom prescribed.
Name and address of the person to whom delivered.
Name and address of the Registered Medical practitioner by whom prescribed.
| Prescription No. | Date | Kind | Quantity | Foreign liquor proscribed | Amount received |
|---|---|---|---|---|---|
| (1) | (2) | (3) | (4) | (5) | |
| Rs. R S. | |||||
Signature of the licensee or his authorised agent or servant.
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