the State of Iowa doing business under the firm name of.........., that his certificate of Registration is in full force and effect for the town of........................ and that he is now and for the last six months has been lawfully conducting a pharmacy in........ township (or town of......), in the county of........ and State of Iowa, as proprietor of such pharmacy, and that he has not been adjudged guilty of violating the laws relating to intoxicating liquors within the last year next preceding the filing of this petition, that he is not the keeper of a hotel, eating house, saloon, restaurant or place of public amusement, that he is not addicted to the use of intoxicating liquors as a beverage, and that he desires a permit to purchase, keep, and sell such liquors for lawful purposes only, for the period of............ years from date of issue of said permit, and that said business is to be conducted at........ . ...Iowa, No....., street (or) lot...... .in said. (block). .Applicant. county. STATE OF IOWA, COUNTY. I, ,first being duly sworn depose and say that I am the applicant named in the foregoing petition, that I have read the foregoing, my petition herein, and know the contents thereof, and that all the allegations thereof are true as I verily believe. Subscribed in my presence and sworn to before me by the said.. [OFFICIAL FORM C.] BOND. (Must be recorded). Know all men by these presents, that we,...... and....... .... as principal as sureties, are held and firmly bound unto the State of Iowa in the penal sum of one thousand dollars, for the payment of which we bind ourselves, our heirs, executors and administrators. The condition of this obligation is such that, whereas, the above bound .......was on the...... day of........ ...190.., by the District (or Superior) Court of..........county (or city), State of Iowa, granted a permit to buy, keep and sell intoxicating liquors for lawful purposes at (Particularly describe the place).................... Now, if the said ..shall well and truly observe and obey the laws of Iowa, now or hereafter in force in relation to the sale of intoxicating liquors, and pay all fines, penalties, damages and costs that may be assessed or recovered against him for the violation of such laws during the time of the continuance of said permit, then this bond to be void, otherwise to be and remain in full force and effect. I..... do solemnly swear (or affirm) that I will well and truly perform all and singular the conditions of the within bond, and keep and perform the trust confided in me to purchase, keep and sell intoxicating liquors. I will not sell, give or furnish to any person any intoxicating liquors otherwise than as provided by law, and especially, I will not sell or furnish any intoxicating liquors to any person who is not known to me personally or duly identified: nor to any minor, intoxicated person or persons who are in the habit of becoming intoxicated; and I will make true, full and accurate returns of all certificates or requests made to or received by me as required by law; and said returns shall show every sale and delivery of such liquors made by or for me during the months embraced therein, and the true signature to every request received and granted; and such returns shall show all the intoxicating liquors sold or delivered to any and every person as returned. Subscribed in my presence and sworn to before me by the said.. We, the undersigned, first being duly sworn, depose and say, and each for himself deposes and says that he is one of the sureties whose name is subscribed to the within and foregoing bond; that he is a resident of the State of Iowa; that he is worth double the sum secured by said bond beyond the amount of his debts and liabilities, to-wit: the sum of ..... dollars; and that he has property liable to execution in said State equal to the sum secured in said bond, to-wit: the sum of . dollars. Subscribed in my presence and sworn to before me by this......day of..... A. D. 189.. ..... 2 Clerk of the Court. Whereas,. of Iowa, Certificate No...... did on the........day of... ..... [OFFICIAL FOrm d.] PERMIT. .... A. D., 189.., publish his notice and file in the office of the clerk of the district (or superior) court in and for..... county (or city), Iowa, his petition and bond, as provided by chapter 6, Code of 1897, for a permit to buy, keep and sell intoxicating liquors for pharmaceutical and mechanical purposes, alcohol for specified chemical medicinal purposes, and wine for sacramental purposes, but for no other purpose whatever, in the (township, town or ward) of...... (describe street, block and number) in the county State of Iowa. of. And it appearing that the said Registered Pharmacist's Certificate of Registration, No....... .., is in full force and effect for the town of above mentioned, and in accordance with the pharmacy law of the State of Iowa, and the court being duly satisfied that the requirements of the law have in all respects been fully complied with, and that said applicant is entitled to a permit as provided by chapter 6, Code of 1897, it is ordered that he be and is hereby authorized, from and after the .day of........ 189.., to buy, keep and sell intoxicating liquors for pharmaceutical and medicinal purposes, and alcohol for specified mechanical purposes, and wine for sacramental purposes, but for no other purpose whatever, at the place aforesaid, so long as his Certificate of Registration is in full force and effect, or until this permit is otherwise revoked according to law. Clerk of District (or Superior) Court, I hereby make request for the purchase of the following liquors: AMOUNT. The actual purpose for which this My true name is I am not a minor, and I reside in. at No. in the county of.. State of. (If for applicant, say myself; if for another give n me, age and residence.) request is made is to obtain the said liquor for. I hereby make request for the purchase of the following intoxicating liquors: KIND. AMOUNT. .189.. purchase of the foregoing described liquors, and that said.. the applicant for the is not a minor and is not in the habit of using intoxicating liquors as a beverage and is worthy of credit as to the truthfulness of the statements in the foregoing request, and my residence is. No....... Street.. (Signature of certifier) Attested by. Reg. Phar. No...... |