STATE OF WISCONSIN
Town of ________
________ County
________ ________, having produced to the undersigned, town clerk of the Town of ________, a receipt showing the payment of $________ to the treasurer of the town, in conformity with an order of the board made on ________ ___, 20__;
This is to certify that in pursuance of the order, a license is granted to ________ ________ to sell at [retail or wholesale] beverages containing less than one-half of one percent of alcohol by volume, on the following described premises: [describe].
This license will expire on ________ ____, 20__, unless sooner revoked.
Dated this ______ day of ________, 20__.
[Signature of town clerk]
