Application For Renewal Of Alcoholic Beverages License Issued By The Comptroller Of Maryland
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1
2Comptroller of Maryland
Approved
OFFICE USE ONLY
MATT Regulatory Division
Check
Alcohol and Tobacco Tax
Date
Number
Louis L. Goldstein Treasury Building
Check
License #
P.O. Box 2999
Amount $
Stub #
Annapolis, Maryland 21404-2999
Deposit__________________
410-260-7327
Date Issued
Date
888-784-0145
Fax# 410-974-3201
Application for Renewal of Alcoholic Beverages License
Issued by the Comptroller of Maryland
Note: This application must be filed on or before March 31 with the Comptroller of Maryland, Annapolis, Maryland; otherwise a new
application and an application fee will be required. Licenses will be issued beginning April 15. Licenses must be displayed on or before
May 1.
9 An individual
9 Partnership
9 Corporation
9 Limited Liability Company
For the use of: (Check one)
Number and class of license now held:
(Copy from current license)
Class(es) of license(s) desired:
(Insert in accordance with instruction sheet attached)
To the Comptroller of Maryland:
Application is made by the undersigned under the provision of Article 2B of the Annotated Code of Maryland, as amended, for
a renewal of (my, our) license, and the applicant(s) submit(s) and certify(ies) to the following information:
1. All the facts and information contained in the original application as submitted are true and unchanged to this time.
2. (I)(We), or anyone connected with the business conducted under the license for which a renewal is herein applied for, have
not furnished and will not furnish to any retail licensee: (1) any sign, display, or other form of advertisement of any value
in excess of the limitation provided under Article 2B, or (2) any money or other thing of value, (3) make any gift, or (4) offer
any gratuity, or (5) any personal service (other than stipulated in official bulletins issued and published by the Comptroller).
*3. (I)(We) produced not more than 27,500 gallons of (my)(our) own wine during the most recent license
year ending April 30: *Class 6 Limited Winery wholesale licensee only.
4. List any offense, or offenses, against the laws of the state or of the United States, have you been convicted of during the
present license year ending April 30:
5. Applicant’s corporation name is:
Applicant’s trade name is:
Location of license premises is:
Describe premises:
Telephone Number:
Fax Number:
E-mail address:
Other Location(s):
6. Applicant(s): Give name(s) and residence(s) - if corporation, list all officers on separate sheet
a.
Name
Title
Residence
b.
Name
Title
Residence
c.
Name
Title
Residence
d.
Name
Title
Residence
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