Form 355 - Wine Festival Permit Application
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1
2WINE FESTIVAL PERMIT
Form
355
APPLICATION
To the Comptroller of Maryland,
Office Use Only
Application is made by the undersigned under the provisions of Article 2B, § 2-103 of the Annotated
Approved ______________
Code of Maryland for the permit indicated above. This application shall be filed with the office of the
Comptroller not less than 30 days prior to Wine Festival. Permit fee: $100.00
Date __________________
Number _______________
1.
Name of Non-Profit organization: ______________________________________________
Permit Year _____________
2.
Mailing address: __________________________________________________________
Stub Number ___________
________________________________________________________________________
3.
Business Telephone no.: ____________________________________________________
4.
Federal tax identification number: _____________________________________________
5.
Attach a copy of your 501(c) determination letter.
6.
The primary purpose of this Wine Festival is to promote Maryland Wines . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
YES
NO
7.
Provide details of the Wine Festival: _________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
8.
Location: _______________________________________________________________________________________________
Wine Festival dates: _________________________________ Hours of Operation: ___________________________________
9.
Does applicant agree to conform to all laws, rules and regulations of the State of Maryland related to the actions
and business activities authorized under this permit? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
YES
NO
10. I agree that at all times during the Wine Festival the permit holder shall have present at all times at least two
agents, one of whom may be the permit holder, who are certified by an approved Alcohol Awareness Program . .
YES
NO
1. Name ____________________________________________________ Phone Number _____________________________
Name of program ____________________________________________________________________________________
2. Name ____________________________________________________ Phone Number _____________________________
Name of program ____________________________________________________________________________________
11. Submit with this application to the Office of Comptroller a list of all winery off-site permit holders who will attend this Wine Festival.
PLEASE NOTE:
(1) YOU ARE REQUIRED TO NOTIFY THE LOCAL LICENSING BOARD OF THE JURISDICTION IN WHICH THE WINE FESTIVAL WILL BE
HELD THAT THE WINE FESTIVAL PERMIT HAS BEEN ISSUED.
12. Must be signed by an officer of non-profit.
AFFIDAVIT
I do solemnly declare and affirm under the penalties of perjury that the contents of this document are true and correct to the best of
my knowledge, information, and belief.
Signature
Printed Name
13. This section must be completed by the authorized representative of the Wine Festival.
CERTIFICATION
I hereby certify that I am the authorized representative of the Wine Festival stated in this Permit located at ____________________
___________________________________ , _________________________________________________ , County/City, Maryland,
and that I assent to the granting of this Permit to the retail licensee stated on this application, and that I authorize the Comptroller of
Maryland, his duly authorized deputies, inspectors and clerks, the Board of License Commissioners of the jurisdiction in which the Wine
Festival is located, its duly authorized agents and employees, and any peace officer of such jurisdiction to inspect and search, without
warrant, the premises upon which the actions and activities under this Permit are to be conducted, at any and all hours.
COM/RAD 756
05/13
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Parent category: Financial