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Treasury Department,
U.S. Internal Revenue
Form No. 1404.
Revised July, 1921.
.
Serial No. of Permit
Maine-H-E83
(To be filled by Director.)
Application For Permit
Under the National Prohibition Act.
(Instructions on Reverse Side.)
Federal Prohibition Commissioner,
Washington, D.C.
The Undersigned, * Eustache N. Giguere, M.D.,
of † Corner Cedar & Canal Streets, Lewiston, Maine,
conduct business as
Physician
Lewiston, Maine, Feb. 20, 1922.----,192
now engaged in or intending to
(Profession.)
at Corner Cedar & Canal Streets, Lewiston, Maine,
Hereby makes application for a permit to ‡ use intoxicating liquors for non-beverage
purposes, to wit: For administration to patients in accordance with REg. 60, Sec. 71.
For compounding such preparations as are necessary for use in professional
practice.
Alcohol for sterilization and laboratory purposes.
QUANTITY DESIRED: 6 quarts of intoxicating liquor and 5 wine gallons of alcohol per annum.
Penal sum and date of bond
None Required.
§
|| The maximum quantity of intoxicating liquor which will be produced or received during and quarterly
period of the calendar year, plus the quantity on hand at the beginning of such period, will be ____
proof gallons of alcohol; _____ proof gallons of whiskey; _____ proof gallons of other distilled spirits; and _____ gallons of wine.
It is hereby certified that the undersigned has not within one year prior to the date hereof violated the
terms of any permit issued under the National Prohibition Act or any law of the United States or of any
State regulating traffic in liquor, and will observe the terms of any permit issued pursuant to this application
and the provisions of all laws and regulations relative to the acts for which permit is issued.
Eustache N. Giguere, M.D.
Subscribed and sworn to before me this
¶ Eustache N. Giguere M.D.
_______ day of __________, 192
_____________________
______________________________
Recommended for APPROVED
(Name and title of officer.)
(Approval or disapproval.)
[signature]
Federal Prohibition Director.
at AUBURN, MAINE.
________________________________________________________________________________________________
* Full name of applicant. If a copartnership, the firm name must be given, followed by the names of all the members. If a corporation, the corporate name and
Contributed to Maine Memory Network by University of Southern Maine,
Franco-American Collection
MMN # 82279
Date: February 20, 1922
Description: A prohibition era permit issued to Dr. Giguere to have, use
and prescribe alcohol for medical use and the sterilization of medical
instruments.
the State under the laws of which organized should be stated, together with the address of the principal office.
† Exact location of the place of business for which permit is desired, giving street and number, if any: otherwise the best description possible.
‡ State concisely in searate paragraphs all acts desired under permit and all purposes for which permit is applied for, referring to section of regulations relating
thereto.
§ The name of the registered pharmacist through whom intoxicating liquors are to be sold at retail must be given.
|| Entries must be made in this paragraph when application is for permit to manufacture, sell, use, import, or export intoxicating liquor.
¶ Signature of applicant to be written exactly as in heading. If a copartnership, the firm name must be written as above, followed by the signature of a partner
authorized to sign for the partnership. If a coproration, the corporation name thereof must be written as above, followed by the signature and title of an officer duly
authorized to sign for the corporation and the impression of the corporate seal, if any.
2-9483