Form Com/att-C5 - Signature Card - Comptroller Of Maryland
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1Comptroller of Maryland
MATT Regulatory Division
Alcohol and Tobacco Tax
P. O. Box 2999
Annapolis, MD 21404-2999
Signature Card
Licensee:
Name
License No. TW
Address
The following signature(s) is (are) of person(s) authorized
Messengers or other persons authorized to
to sign requisitions for Maryland Cigarette Tax Stamps.
pick up stamps must sign here.
Notice of change of signature must be given immediately.
Signature
Signature
Print or type name
Print or type name
Signature
Signature
Print or type name
Print or type name
Signature
Signature
Print or type name
Print or type name
I hereby certify that the above are the genuine signatures of those authorized to sign on behalf of
Date
Signature and title
Print or type name of signature
COM/ATT-C5 Rev. 7/07
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Parent category: Legal