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Kind of Liquor

Purpose for Quantity of Liq. / Which Liquor is Date of delivery uor

to be used by to Consignee.

Consignee.

CONSIGNEE'S STATEMENT TO CARRIER. To....

(Name of Carrier): I do hereby solemnly certify upon my honor and under penalty of the law that my full and true name is..... that I am the bona fide consignee to whom the intoxicating liquor referred to in the foregoing record is consigned; that I have never been convicted of any violation of the law entitled: “An Act to restrict the manufacture, possession and use of intoxicating liquor within prohibition territory”; that each and every statement made in said record is true and correct; that I will not use or suffer any other person to use said liquor for any other purpose than the one therein specified, and will keep said liquor at the place designated until used. Signed at.... ..., Illinois, this. ...day of.

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(Signature of Consignee)

(Signature of Witness) Prorided, the phrase, "Have never been convicted” when applicable to a druggist, shall be construed in harmony with section ten (10) of this Act. Vo carrier shall, within prohibition territory, turn over or de

hver any intoxicating liquor under any circumstances whatsoever to any person who has been convicted of any violation of any provision of this Act, to any minor, to any person intoxicated, to any person in the habit of getting intoxicated, to any person under a fictitious name, to any consignee who is not personally known to the carrier, to any person other than the bona fide consignee, or to any consignee whomsoever except when consigned as follows:

First-To a druggist: Provided, it shall be sufficient for the label on the package of such liquor and the record to show that such liquor is for a druggist without setting forth the purposes for which he may dispose of the same.

Second-Wine: To any bona fide church or religious society for sacramental purposes. Provided, the priest, rabbi, minister or some authorized official of such church or society, who is personally known to the carrier, shall sign the statement for and on behalf of such church or society.

Third-Alcohol: To any person for chemical, mechanical or manufacturing purposes.

All intoxicating liquors while in the custody of any carrier shall be subject to inspection of all peace officers and such officers shall be permitted to enter the premises and vehicle of any carrier for that purpose. Whoever, by himself or another, either as principal, clerk or servant, shall fail, refuse or neglect to discharge any duty imposed by this section, or shall make any false entry in any such record book, or deliver any intoxicating liquor to any consignee except for the foregoing purposes, or before the consignee shall have signed the foregoing statement in the presence of a witness, or do any other act prohibited by this section, shall for each offense be punished in the manner prescribed in section eight (8) of this Act.

$ 8. Whoever shall violate any provision of either of sections three (3), four (4), five (5), six (6), seven (7), or thirteen (13) of this Act, or shall do or neglect, omit or refuse to do, anything required or prohibited by this Act when there is no specific penalty or punishment imposed by this Act for such act or omission, shall for each offense, upon conviction thereof, be fined not less than fifty dollars ($50.00) nor more than five hundred dollars ($500.00), or imprisoned in the county jail for not less than twenty (20) days nor more than sixty (60) days, or both in the discretion of the court. If any person shall be convicted of violating any provision of any such sections, and shall subsequently violate any provision of any such sections, for such second and each subsequent violation he shall, upon conviction thereof, be fined not less than two hundred dollars ($200) nor more than five thousand dollars ($5,000), and be imprisoned in the county jail for not less than ninety (90) days nor more than one (1) year, in the discretion of the court.

$ 9. Nothing in this Act shall be construed to forbid any druggist, who has received the permit provided for in section two (2), from keeping intoxicating liquor and dispensing the same, so long as he shall faithfully provide and keep all the records, prescriptions and applications provided for herein: nor to prohibit him if he be a registered pharma

cist, local registered pharmacist or registered assistant pharmacist, nor to prohibit any registered pharmacist or local registered pharmacist o: registered assistant pharmacist employed by such druggist within his pharmacy, from dispensing intoxicating liquor for medicinal purposes only upon the written prescription in each instance of a duly licenza physician personally known to such druggist and actively engaged in the practice of his profession, provided such prescription shall be written in ink, addressed to such druggist, dated and signed by such physician, and shall state the full and true name and residence address (statin: the street and house number if there be such, if not then otherwise distinctly designating his place of residence) of the person for whom the liquor is prescribed, and likewise the place where such liquor is to be administered, and that such physician has personally examined such person and that he is in immediate need of the kind and amount of liquor prescribed, and state the name and address as aforesaid, of the person to whom such druggist is to deliver such liquor; and provided such druggist, before delivering such liquor, shall cancel such prescription by plainly writing or stamping, in ink, across the face thereof the word "cancelled”, stating the date (giving the date and hour) of such delivery: and provided the pharmacist filling such prescription shall sign his name to such cancellation; and provided further, that such druggist, before such delivery shall make a true and legible record of such sale in a permanently bound book, which the druggist shall provide for that purpose and that purpose only, giving the full and true name and residence address, as aforesaid, of the person to whom delivered, the name and residence address, as aforesaid, of the person for whom the liquor is prescribed and the place where it is to be administered, the kind and quantity of liquor sold, the purpose for which it is sold, the date of the prescription, the name and address of the physician issuing the same, and shall secure a receipt upon such record book for such liquor signed by the person to whom it is delivered, and before delivering such liquor shall permanently attach to the bottle or vessel a label containing the name and address of the druggist making the sale and a copy of the aforesaid record, and provided such druggist shall keep such record book and all prescriptions on file at such pharmacy for the space of five (5) years, open to the full and free inspection of the public at all times during business hours. Provided, such druggist may, without such prescription, by strictly complying with all the foregoing provisions, sell wine for sacramental purposes only to any bone fide church or religious society upon the written application in each instance of the governing body of such church or society personally presented by a priest, rabbi, minister or other official of such church or society who is personally known to such druggist to be such ; and alcohol for mechanical, chemical or manufacturing purposes only to any person who is personally known to such druggist and who has never been convicted of any violation of this Act, and is not a minor, or an intoxicated person, or a person in the habit of getting intoxicated, upon the written application in each instance personally presented by such person. All such applications shal! be written in ink, addressed to such druggist, dated and signed, and

shall state the kind and quantity of wine or alcohol required, and the purpose for which it is to be used, and the full and true name and address as aforesaid, of the purchaser, and likewise the place where the wine or alcohol is to be kept and used, and that he solemnly certifies upon his honor and under penalty of the law that he will not use or uifer any other person to use, such wine or alcohol for any other purpose than the one specified in the application, and will keep the liquor at the place designated until used. Such application shall be cancelled, filed and kept as aforesaid, and shall be substantially in the following form:

PURCHASER'S APPLICATION TO DRUGGIST. To....

(Name of Druggist): I do hereby solemnly certify upon my honor and under penalty of the law that my full and true name is...

; that I reside at..

(house number and street) in the.....

....... (city or village) of.. in the county of.

Illinois; that I have never been convicted of any violation of the law entitled: "An Act to restrict the manufacture, possession and use of intoxicating liquor within prohibition territory”; that I require....

(quantity) of . (wine or alcohol) to be used for. (sacramental, mechanical, chemical or manufacturing) purposes at

.. (house number and street) in the... (city or village) of.....

.. in the county of... Illinois; that I will not use or suffer any other person to use such

(wine or alcohol) for any other purpose than the one above specified and will keep the...... (wine or alcohol) at the place designated until used.

(Signature of Purchaser) $ 10. Any druggist who shall, by himself or another, within prohibition territory, sell, give away, or in any manner dispose of any intoxicating liquor, or in any manner aid any person in procuring any intoxicating liquor, in any quantity whatsoever. without strictly complying with sections two (2) and nine (9) of this Act shall, for each offense, be fined not less than two hundred dollars ($200) nor more than four hundred dollars ($100) or imprisoned in the county jail for not less than ten (10) days nor more than thirty (30) days or both, in the discretion of the court; and it shall be unlawful for him, either with or without a permit, to receive or keep any intoxicating liquor within prohibition territory for the period of two (2) years after such first conviction. The court in which such conviction is had shall send notice to the Attorney General, upon receipt whereof the permit provided for in section two (2) shall be forthwith revoked for the period of two (2) years after such conviction. If any druggist shall be convicted of violating any provision of this section, and shall subsequently violate any provision of this section, he shall, upon conviction thereof, for each offense, be fined not less than four lunrired dolar- 1$100) or more

than eight hundred dollars ($800), and be imprisoned in the county jail not less than ninety (90) days nor more than one (1) year, in the discretion of the court; and it shall be unlawful for him, either with or without a permit to receive or keep any intoxicating liquor within pruhibition territory for the period of five (5) years after such second conviction; and if he be a registered pharmacist, local registered pharmacist, or registered assistant pharmacist, it shall be part of the judgment upon such second conviction that his certificate to practice pharmacy shall be forthwith revoked, and the court before which such convictiel is had shall so order and forthwith cause a copy of such order to be sent to the Director of Registration and Education, upon receipt whereci such certificate shall be forthwith revoked by the Department of Registration and Education and shall not be renewed for the period of two (2) years after such revocation, and the court shall further send notic to the Attorney General, of such conviction, and upon receipt whereuf the permit provided for in section two (2) shall be forthwith revoker? for the period of five (5) years after such conviction. A certified transcript of the judgment of such conviction shall be sufficient evidence of such conviction to such Department of Registration and Education and Attorney General. And in like manner if he shall subsequently violat any provision of this section, for such third violation he shall, for each offense, be fined not less than five hundred dollars ($500) nor more than one thousand dollars ($1,000), and be imprisoned in the penitentiary for not less than one (1) year nor more than three (3) years and if he be a registered pharmacist, local registered pharmacist, or registered assistant pharmacist, it shall be part of the judgment upon such third or any subsequent conviction, that his certificate to practice pharmacy shall be forthwith revoked as aforesaid, and he shall forever thereafter be barred from practicing pharmacy in this State, or holding any permit to manufacture, sell or keep for sale, intoxicating liquor.

$ 11. Any registered pharmacist, local registered pharmacist. or registered assistant pharmacist who shall sell, give away, or in any manner dispose of any intoxicating liquor, or in any manner aid any person in procuring any intoxicating liquor in any quantity whatsoever, within prohibition territory, without strictly complying with sections two (2) and nine (9) of this Act, shall for each offense, be fined not less than one hundred dollars ($100) nor more than four hundred dollars ($400), or be imprisoned in the county jail for not less than thirty (30) days nor more than ninety (90) days or both, in the discretion of the court. If any such pharmacist shall be convicted of violatin. any provisions of this section and shall subsequently violate any provision of this section, he shall for each offense, be fined not less thar two hundred dollars ($200) nor more than eight hundred dollars ($800) and be imprisoned in the county jail for not less than ninety (90) days nor more than one (1) year, in the discretion of the court; and it shall be part of the judgment upon such second conviction, that his certificate to practice pharmacy shall be forthwith revoked, and the court before whom such conviction is had shall so order and fortha: cause a copy of such order to be sent to the Director of Registration and

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