Date of Sale Name of Poison or Preparation Quantity Purpose Signature of Buyer or Person to Whom Delivered Address By Whom Introduced By Whom Sold
the date of such sale, and the initials of the dispenser, the signature and address of the person to whom delivered, and the name of the person, if any, who introduced him, the name and quantity of the poison sold or furnished, and the purpose for which same is to be used.
Source: SL 1893, ch 132, § 12; SL 1897, ch 103, § 2; RPolC 1903, § 280; RC 1919, § 7844; SL 1929, ch 124, § 1; SL 1935, ch 114, § 1; SDC 1939, § 22.1201.