Description of receptacle to be used (vehicle, vessel, trailer, stall):
I/we hereby apply to Derry City Council for the grant/renewal/transfer of a licence to use the above premises, vehicle, vessel or stall as a sex establishment. (N.B. Any person who, in connection with this application, makes a false statement which he knows to be false in any material respect or which he does not believe to be true, shall be guilty of an offence and liable on summary conviction to a fine not exceeding £20,000.)