Form 385 - Application For A Brewery Special Event Permit Page 2
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1
2APPLICATION FOR A BREWERY
Form
385
SPECIAL EVENT PERMIT
Affidavit
I do solemnly declare and affirm under the penalties of perjury that the contents of the foregoing document are true and
correct to the best of my knowledge, information and belief.
Signature
Type or print name
Title
Date
Third Party Checks
Affidavit
I do solemnly declare and affirm under the penalties of perjury that the contents below are true and correct to the best of my
knowledge, and that I am authorized and empowered to issue a check and make payment for the license/permit fee on behalf of
the applicant.
Name of Corporation; Partners of Partnership; or Individual (include Trade Name)
Complete Mailing Address
Signature of Owner, Partner or Corporate Officer
Title
Federal Identification Number and/or Social Security Number
Date
Contact Information
Comptroller of Maryland
Revenue Administration Center
Licensing and Registration
P.O. Box 2999
Annapolis, Maryland 21404-2999
410-260-7980 or 800-MD-TAXES
COM/RAD-385
COM/RAD-012
13-49
Revised 06/12
06/13
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Parent category: Financial