Form Com/att-009 - Application For A Class Beer, Wine And Liquor License

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Comptroller of Maryland
OFFICE USE ONLY
OFFICE USE ONLY
MATT Regulatory Division
Check
Alcohol and Tobacco Tax
License #
Number
Louis L. Goldstein Treasury Building
Check
P.O. Box 2999
Stub#
Amount $
Annapolis, Maryland 21404-2999
Deposit
Date Issued
410-260-7327
Date
888-784-0145
Fax # 410-974-3201
Approved
Date
Application for a Class
Beer, Wine and Liquor License
E, F or G
WATER VESSEL CLASS E - $150.00 license fee
RAILROAD CLASS F -
$200.00 license fee
AIRPLANE CLASS G -
$200.00 license fee
NOTE: Renewal applications must be received no later than March 31.
G New Application
G Renewal of License No.
Check one:
G Partnership
G Corporation
G Limited Liability Co.
G Individual
Check one:
NOTE: Beer, Wine and Liquor License is only available to boats transporting for hire passengers from ports in Maryland to other ports in Maryland
or to coastal ports in other states or foreign ports; or boats licensed to operate tours within Maryland waterways; to operators of cars on railroads;
and to operators of airplanes.
TO THE COMPTROLLER OF MARYLAND:
Application is made by the undersigned under the provisions of Article 2B, as amended, title “Alcoholic Beverages”, for the class license indicated
above, and the applicant(s) submit(s) and certify(ies) to the following information required by the article.
Application may be made by any three officers, or three employees residing in this state, duly authorized by the corporation to apply for the
license.
1. APPLICANTS
(1)
(2)
(3)
Name
Residence
Home Phone
Date of Birth
Place of Birth
Social Security No. *
Title or Position
held in Organization
MD Resident Since
MD Resident Since
MD Resident Since
*
The disclosure of applicant’s Social Security Number is mandatory and will be used for background investigations pursuant to Section 10-201
of Article 2B of the Annotated Code of Maryland.
2.
a.
Name and trade name (if applicable) of company on whose behalf license is desired:
b.
Mailing address:
(street address or post office box)
(city/state)
(nine digit zip code)
c.
Physical location if mailing address is a post office box
(street address)
-over-
COM/ATT-009
Rev. 7/07

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