306368-1941-New-Territories-Regulation-Ord--1910-Rules-under-sections-6-and-6A-of-the — Page 17

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THE HONG KONG GOVERNMENT GAZETTE, NOVEMBER 28, 1941.

FORM B.

Application for Food Shop Licence.

[rule 12 (3)]

The District Officer,

·I, the undersigned, hereby notify the District Officer that I propose

to carry on the business of

on the premises known as No.

Street

floor, and to request that the said premises be duly

licensed as a

I declare that neither I nor any member of my family is financially

interested in any Food shop Licence or Market Stall other than the

following :-

Hong Kong,

.194

Signature of Applicant.

現擬在

號

店

樓 姓

街門牌第

民俾特

府得赴設第名

台前恩准施行 遵例營生則沾恩靡旣切赴理民府 署禀請懇給牌照將該店注册俾得

品舖店牌照或街市檯位生意 或家中任何一人并無投資經營食 茲特聲明除左列生意之外具禀人

一九四

年

叩

月

禀日