Application For A Farmer'S Market Permit - Comptroller Of Maryland
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1Comptroller of Maryland
Office Use Only
Revenue Administration Division
Approved ___________________
P.O. Box 2999
Date _______________________
Annapolis, Maryland 21404-2999
Permit # ____________________
APPLICATION FOR A FARMER’S MARKET PERMIT
Stub # ______________________
Date: _____________________________
To the Comptroller of Maryland,
Application is made by the undersigned under the provisions of Article 2B, § 2-101(x) of the Annotated Code of Maryland for the
permit indicated above.
1. Retailer name or trade name: _____________________________________________________________________________
2. Mailing address: ______________________________________________________________________________________
3. Business Telephone no.: ________________________________________________________________________________
4. Federal tax identification number: ________________________________________________________________________
5. Retail License No. ________________________________ Political Subdivision (county/city) _________________________
6. Check the type of retail license held:
Off-Sale only
On-Sale and Off-Sale
7. State complete name, address, and political subdivision (county/city) where Farmer’s Market is located: _________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
8. Farmer’s Market year: _ __________________________________________________________________________________
9. Dates: _____________________________________________________ Hours of Operation: ________________________
10. Does applicant agree to conform to all laws, rules, and regulations of the State of Maryland related to the actions and business
activities authorized under this permit?
Yes
No
PLEASE NOTE:
(1) YOU ARE REQUIRED TO NOTIFY THE LOCAL LICENSING BOARD OF THE JURISDICTION
IN WHICH THE FARMER’S MARKET WILL BE HELD THAT THE FARMER’S MARKET PERMIT
HAS BEEN ISSUED.
(2) ONLY ONE PERMIT MAY BE ISSUED AT ANY ONE TIME TO A FARMER’S MARKET.
11. Must be signed by the retail licensee.
AFFIDAVIT
I do solemnly declare and affirm under the penalties of perjury that the contents of this document are true and correct to
the best of my knowledge, information, and belief.
_____________________________________
_______________________________________ Title:
Owner
Partner
Officer
Signature
Printed Name
12. This section must be completed by the authorized representative of the Farmer’s Market.
CERTIFICATION
I hereby certify that I am the authorized representative of the Farmer’s Market stated in this Permit located at ________________,
________________________, County/City, Maryland, and that I am listed in the Farmer’s Market Directory of the Maryland
Department of Agriculture, and that I assent to the granting of this Permit to the retail licensee stated on this application, and that I
authorize the Comptroller of Maryland, his duly authorized deputies, inspectors and clerks, the Board of License Commissioners of the
jurisdiction in which the Farmer’s Market is located, its duly authorized agents and employees, and any peace officer of such jurisdiction
to inspect and search, without warrant, the premises upon which the actions and activities under this Permit are to be conducted, at any
and all hours.
_____________________________________
_______________________________________ _ ___________________________________
Signature
Printed Name
Date
COM/RAD 754
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