Form Com/att19 - Monthly Report Of Retail License Activity Page 2

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Comptroller of Maryland
MATT Regulatory Division
Alcohol and Tobacco Tax
P. O. Box 2999
Annapolis, Maryland 21404-2999
Phone: 410-260-7314
Fax: 410-974-3201
1. City or County
Page
of
2. Type of Transaction(s):
Add
Delete
Change
3. Central Registration Number:
11. City or County License Number:
4. Class and Type of License:
On
Off
12. Transaction Date:
5. Entity or Corporate Name
6. Trade Name
7. Retailer's Address:
8. Retailer's Telephone Number:
9. Licensee 1:
Licensee 2:
Licensee 3:
10. Remarks:
2. Type of Transaction(s):
Add
Delete
Change
3. Central Registration Number:
11. City or County License Number:
4. Class and Type of License:
On
Off
12. Transaction Date:
5. Entity or Corporate Name:
6. Trade Name:
7. Retailer's Address:
8. Retailer's Telephone Number:
9. Licensee 1:
Licensee 2:
Licensee 3:
10. Remarks:
COM/ATT19
Revised 6/08

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