Form Com/att-011 - Application For A Statewide Caterer'S (Scat) License

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Comptroller of Maryland

Office use only

MATT Regulatory Division

Approved

Check

Alcohol and Tobacco Tax

Number

Date

Louis L. Goldstein Treasury Building

Check

P.O. Box 2999

Amount

License #

Deposit

Annapolis, Maryland 21404-2999

Stub #

Date

410-260-7327

888-784-0145

Application for a Statewide Caterer's (SCAT) License

(See back page for guidelines and instructions.)

For the use of: (Check One) An individual 9

Partnership 9

Corporation 9

Limited Liability Co. 9

General 9

Limited 9

Check Type of License desired:

If applying for a Limited License, list the three contiguous political subdivisions of the state in which you plan to operate:

General SCAT License

Annual Fee

$2,000.00

Limited SCAT License - More than 600,000 but less than 1,000,000 total population

Annual Fee

$1,500.00

Limited SCAT License - More than 300,000 but less than 600,000 total population

Annual Fee

$1,000.00

Limited SCAT License - Not more than 300,000 total population

Annual Fee

$750.00

Do not remit any license fee with this application. If your application is approved, you will be advised of the appropriate license fee based upon

provisions of the law.

Date

Application is made by the undersigned under the provisions of Article 2B, as amended, title “Alcoholic Beverages”, for the type of license checked

above, and the applicant(s) submit and certify to the following information required by law:

1. Applicants*

(1)

(2)

(3)

Name

Residence

Home Phone

Date of Birth

Place of Birth

Social Security Number**

Position

Qualifying Maryland Resident?***

Yes

MD Resident Since

In the case of a corporation, the law requires three officers to apply as license applicants, unless less than three exist. (In the latter case, submit

supporting documentation.)

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.

***

At least one applicant must be a voter and taxpayer in Maryland presently and for the two immediately preceding years. In case of partnership, all

individuals must meet this requirement.

Name and/or trade name

Location of desired licensed premises/principal office

Description of premises to be covered under license applied for (lot, type, size, and construction of building)

COM/ATT-011

Rev. 7/07