Form 370-5 - Solicitor'S Permit Application Page 2
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1
2SolIcItor’S PermIt APPlIcAtIoN
Form
Page 2
370-5
2013
1. 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
No
2. Does the applicant agree that he or she will not furnish anything of value to a retail licensee except
advertising and related items provided by Section 12-104 of Article 2B of the Annotated Code of Maryland
and regulations and bulletins issued by the Comptroller? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
3. Are you or any member of your immediate family listed as a retail license applicant or employed by a retail
licensee, or do you have a direct or indirect financial interest in such an establishment? . . . . . . . . . . . . . . . . .
Yes
No
If your answer to this question is yes, attach explanation along with statement you will not solicit this account.
4. Has the applicant ever been convicted of a felony by any state or federal court? . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
If your answer to this question is yes, explain in detail below.
5. Has the applicant been convicted of a violation of the laws of the United States, Maryland or any other state
concerning alcoholic beverages, gaming or gambling? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
If your answer to this question is yes, explain in detail below.
Name
offense
court
Date
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
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
Date
Third Party Checks
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
Important
The Solicitor Permit fee is $50.00. Your check made payable to “Comptroller of Maryland” should be remitted with your application.
Mail or submit your application to the Licensing and Registration Unit in the Annapolis office.
Applicants do not have to personally appear to obtain a permit. However, an application must be submitted and a permit issued
prior to engaging in any activity authorized by a Solicitor Permit. The permit must be physically carried on your person at all
times while engaging in the activity.
It is preferable that applicants mail their application to the address below at least 10 days in advance of need. Personal appearances
can only be handled with a prior appointment.
Comptroller of Maryland
Revenue Administration Center
Licensing and Registration
P.O. Box 2999
Annapolis, Maryland 21404-2999
410-260-7980 or 800-mD-tAXeS from elsewhere
Solicitor’s Permits Expire October 31 Annually
COM/RAD-370-5
12-49
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