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Part 1 Serial Number:I/We apply for a premises license under section 17 of (Insert name(s) of applicant) the Licensing Act 2003 for the premises described in Part 1 below (the premises) and I/we are

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123 Charlwoods Road EG is a fictional address used for example purposes.

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Individuals or companies who own or occupy property at 123 Charlwoods Road EG may be required to file the necessary forms.

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