Application For Charity Wine Auction Permit - Comptroller Of Maryland Page 2
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1
2Owner of Premises Statement
Section 3
Physical description of premises applied for
The premises is owned by
Whose mailing address is
(I) (We)
certify that (I am) (We are) the owner(s) of the above described premises, and (I) (We) hereby consent to the use of the
premises in the conduct of the businesses to be engaged in under the permit applied for and (I) (We) authorize the
Comptroller of the State of Maryland and his duly authorized inspectors to inspect and search without warrant, the
premises so described at any and all hours.
WITNESS (My) (Our) hand(s) this
day of
20
WITNESS
(L.S.)
Owner’s signature
WITNESS
(L.S.)
Owner’s signature
Section 4
A.
Permit fee is $10.00 (remitted herewith)
B.
Prepayment of taxes:
Within seven (7) days of the date of the auction (see Section 1F), applicant must remit an estimated prepayment of
the wine tax on wine anticipated to be sold at auction on which the tax has not already been paid (reference
Section 2-101 (9) (10), Article 2B, Annotated Code of Maryland).
Note:
Within 30 days from the date of the auction, our report Form 34-12 ATT is to be submitted to the Alcohol
and Tobacco Tax office.
Section 5
A.
Extract from the Maryland Law: If any signed statement, report, affidavit or oath required under the provisions
of the Alcohol Beverages Law shall contain any false statement, the offender shall be deemed guilty of perjury
and upon conviction thereof, shall be subject to the penalties provided by law for that crime
.
By my signature below I understand that while I am making this application on behalf of the listed charitable
organization, I will be considered a co-applicant and as such will be held personally accountable for filing report
Form 34-12 ATT, paying the applicable excise tax and otherwise complying with the provisions of Article 2B.
Signature of applicant (if a corporation, the president, vice president or secretary-treasurer)
(L.S.)
Corporate Officer
Organizational Official
B.
State of
County of
This is to certify that on the
day of
20
,
before me the subscriber, a
in and for the State of
personally appeared
who represented
himself (herself) to be
of the
Owner, partner or title of corporate officer
Trade or corporate name
and made oath in due form of law that the statements contained herein are true and correct to the best of his (her)
knowledge and belief.
Whereof Witness My Hand and Seal
(Seal)
Officer administering oath
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