Poison Slave Permit

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Selnar: Imperial Cos

Poison Slave Permit

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Let it be recorded that the slave known as (Name (SL Name)) is being registered as a poison slave in Selnar, and will be required to wear a mask at all times when in public for the protection of citizens, residents, visitors and their property.

Details of poison: (Effects of poison, information regarding antidotes, duration of effects, deadliness, etc)

The owner of the above referenced property verifies the accuracy of the information provided in this document. By affixing their seal below, they assume all responsibility should a free or slave be injured, maimed, or killed by the registered poison slave. Should any of the information provided be found to be deliberately false, the owner may face criminal charges for fraud and public endangerment.

Owner:

Seal:

Date:

This document is not considered valid unless it contains Seal of a Scribe. Document or copy of said document shall be on file in the Hall of Records. A duplicate of this document must be kept on record with the infirmary.

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Certified by: Scribe of Selnar

I have reviewed the terms of this document. A copy of this scroll has been provided to all involved parties to utilize within city, and a copy filed in the Hall of Records 

Signature:

Seal: 

Date:

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Filed by: 

Signature:

Seal: 

Date: