Bismarck daily tribune. [volume] (Bismarck, Dakota [N.D.]) 1881-1916, 1903-03-23

Sales f0COTucu. Cudlty.J fAhy uiut3
gist having permit to sell intoxicat-
ing liquors under the provisions of this
chapter, may sell the same only by
himself in person, or by a clerk who
is a registered pharmacist or assistant
under the laws Of this
state, for medical purposes only, upon
the printed or written affidavit of the
applicant, setting forth the particular
medical purposes for which such
liquor is required, the kind and guam
tity desired; that 1t is necessary and
needed for the particular pur-
pose. by the patient to be named; and
that it is not intended for beverage.
nor to sell or give away; that the
applicant is over twenty-one years OF
age; which affidavit shall be in the
form and subscribed by the
applicant in ink:
State of North Dakota, County
OF SIS.
No. ...... Date
l, the undersigned, do solemnly
swear that my real name is .........
that l reside at
III in city the
SlIcet anu AuHOSi AAuoS oO oi'SA' -
in town or village, name Of street
must be given; If in the country the
quarter section, township and range;)
county OF. state OF
........; that ...... of. ..........
is necessary and actually needed by
to be used as medi-
cine for the disease of ..............;
that it is not intended as beverage.
nor to sell nor to give away, and that
l am over twenty-One years of age.
l therefore make application to-.
druggist, for said liquor.
Applicant.
Subscribed in my presence and
sworn to before me this ........ day
OF ..............., ~. -.
Pharmacist.
State of North Dakota, County
or ............... SIS.
On this. day of ...............
in the year ......, before be person
ally appeared
known to me Cor proved to me on
oath of to be
the person who is described in and
who executed the within instrument
and acknowledged to me that he exc.
cuted the same.
Pharmacist.
And such druggist may sell intox-
icating liquors for mechanical. scien-
tific. and wine for Sacramental pur.
poses only, upon the written or printed
affidavit of the applicant, setting forth
the particular purpose for which such
liquor is required, the kind and guam
tity desired, that it is not intended tC
be used as a beverage, nor to sell mol
to give away, and that it is intended
! only for his own use, and that the
applicant is over twenty-one years Of
age Such affidavit shall be in the
following form, and subscribed by the
applicant in ink:
No. Date, ............'
State of North Dakota, County
OF SIS
|. the undersigned, do solemnly
swear that my real name is .......,
..........; that l reside at.
| (if in a city, the street and number
must be given, and if in a town OF
village the name of the street mus
be given; if in the country the quarter
section, township and range,) count!
of .......... state of. f...........
that ........ of. of................ is re
quired by myself to be used fol
............ purposes, to be used fol
.............; that it is not in
tended for a beverage, nor to sell, mol
to give away. and that l am ovel
twenty-one years of age. I therefore
make application to ................
druggist, for said liquor.
|
Applicant.
sworn to before me this ...... day
! or ................, ~.
Pharmacist
State of North Dakota, County
OF ................ SIS.
On this ... day of .............
in the year ......, before me person
ally appeared ....................
known to me to be, Tor proved to me
on oath of ................O to be
the person who is described in anG
who executed the within instrument
and acknowledged to me that he exc
cuted the same.
Pharmacist.
And there shall be but one sale ant
one delivery of not to exceed onehal
pint of any intoxicating liquors or
any one affidavit to any one person
in each twenty-four hours, but no drug
gist shall permit the drinking on hi:
premises, nor in any apartment con
nected Herewith and under his con
troll any of the intoxicating liquor.
purchased by affidavit or otherwise
provided, such druggist shall be per
mitted to sell any of the liquors men
toned herein, in quantities not les
than one gallon, to any other druggis
within the state holding a permit a
provided in this chapter. The aft
dayits provided for in this section sha
be made before the pharmacist O
assistant pharmacist making sale {
, such liquors, upon proper printe