And such druggist may sell intoxicating liquors for mechanical, scientific and wine for sacramental purposes only upon the written or printed affidavit of the applicant, setting forth the particular purpose for which such liquor is required, the kind and quantity desired, that it is not intended to be used as a beverage, nor to sell nor 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...
I, the undersigned, do solemnly swear that my real name is...........; that I reside at...... county, state of......... that...... of....... is required by myself to be used for....... purposes, to be used for........: that it is not intended for a beverage, nor to sell nor to give away, and that I am over twenty-one years of age. I therefore make application to........ druggist, for said liquor.
....................Applicant
Subscribed in my presence and sworn to before me this.... day of........, 18...
.................Pharmacist.
And there shall be but one sale and one delivery on any one affidavit, but no druggist shall permit the drinking on his premises, nor in any apartment connected therewith and under his control, any of the intoxicating liquors purchased by affidavit or otherwise: provided, such druggist shall be permitted to sell any of the liquors mentioned herein, in quantities not less than one gallon, to any other druggist within the state holding a permit as provided in this chapter. The affidavits provided for in this section shall be made before the pharmacist or assistant pharmacist making sale of such liquors upon proper printed blanks, which it is hereby made the duty of the county Auditor of the county in which such sales are made to furnish to such druggist at a cost equal to the actual and necessary outlay made therefor by him. Such blanks shall be in series of 100 each, numbered from 1 to 100 consecutively, and bound in book form, each series being of uniform style throughout, except that no two blanks of the same series shall be of the same number. It shall be the duty of the county auditor to incorse each such book with the date of delivery and to whom made, to sign such indorsement and attest to the same with his official seal, and to keep two exact printed copies, except as to numbers, of the blanks of each series, one of which shall be filed in his office and one in the office of the county judge; he shall also keep a record of the series, and of the number of each series, of such blanks furnished to each druggist, and shall, within ten days after the same are delivered to such druggist, file a copy thereof, together with a copy of the blank affidavits, in the office of the county judge of his county. For such services the county auditor shall be entitled to a fee of twenty-five cents for each series of blanks so furnished to be paid by the druggist obtaining such blanks.
All pharmacists and assistant pharmacists are hereby empowered to administer oaths for the purposes of this chapter, and no such affidavit shall be received by any pharmacist or assistant pharmacist until 1338
