Application For Charity Wine Auction Permit - Comptroller Of Maryland
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1
2Comptroller of Maryland
OFFICE USE ONLY
Permit#
MATT Regulatory Division
Check# _____________________
Stub#
Alcohol and Tobacco Tax
Check
Date
Louis L. Goldstein Treasury Building
Amount$
Issued
Deposit______________________
P. O. Box 2999
Date
Annapolis, Maryland 21404-2999
1-888-784-0145
Approved ___________________
410-260-7314
Date _______________________
Fax# 410-974-3201
Application for
Charity Wine Auction Permit
Section 1
A. Name of Charitable Organization
B. Mailing Address
C. Telephone number and area code
D. Premises in Maryland where event is to be held
Yes 9
No 9
E. Is this a retail license premise?
F. Date event is to be conducted
G. Federal Identification Number
H. Social Security number of organization
(Official Making Application)
Section 2
A. Has the applicant ever been convicted of a felony by any state or federal court? . . . . . . . . . . Yes 9
No 9
B. Does the applicant agree to conform to all the laws, rules and regulations of the state of
Maryland relating to the business in which he proposes to engage under this permit? . . . . . . Yes 9
No 9
C. Does the applicant authorize the Comptroller of Maryland and his duly authorized
personnel to search without warrant any vehicle, railroad cars, vessel, aircraft or
premises used in the business to be conducted under this permit at any and all hours
agreeable to the laws of the State of Maryland? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes 9
No 9
D. Has the applicant ever been convicted of a violation of the law of the United States,
Maryland or any other state concerning alcoholic beverages, gaming or gambling? . . . . . . . Yes 9
No 9
(If yes, explain in detail on separate paper - list offense, court, date, etc.)
E. Section 1-204 of the Tax General Article of the Annotated Code of Maryland titled “Workers
Compensation Compliance” requires the evidence of such compliance prior to the issuance of
any permit by this office. The applicant hereby affirms (check one):
9 a. the applicant is not an employer required to provide coverage by the Maryland
Workers Compensation Law; or
9 b. the applicant is an employer required to provide employee coverage by the Maryland
Workers’ Compensation Law and has secured such coverage. As evidence of such coverage, the
following is submitted:
1. Name of insurance company
2. Policy or binder number
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