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10-7 - NATIONAL FAMILY BEER AND/OR WINE EXHIBITION (Comptroller of Maryland)

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COM-FED/RLS-10-7 Rev. 09/19
MARYLAND
FORM
10-7
APPLICATION FOR
NATIONAL FAMILY
BEER AND/OR WINE
EXHIBITION PERMIT
Oce Use Only
Check No. _______________
Check Amt. ______________
Deposit Date _____________
Approved ________________
Approval Date ____________
Number _________________
Stub ___________________
Year ___________________
Section 1
A.
NameofNationalFamilyBeerand/orWineAssociation:_______________________
B.
MailingAddress:______________________________________________________________
____________________________________________________________________________
C.
TelephoneNumberwithAreaCode:__________________FaxNumber:__________________
D. FederalIdenticationNumber:
-
E. PremisesinMarylandwhereeventistobeheld: ____________________________________
__________________________________________________________________________
F. Isthisaretailalcoholicbeveragelicensepremise: ................... Yes No
G. Date(s)eventistobeconducted: _______________________________________________
Section 2
A. HastheapplicanteverbeenconvictedofafelonybyanystateorFederalCourt? ........................ Yes No
B. Doestheapplicantagreetoconrmtoallthelaws,rulesandregulationsofthestateofMarylandrelatingtothe
businesswhichisproposedtobeengagedinunderthispermit? ...................................
Yes No
C. DoestheapplicantauthorizetheComptrollerofMarylandandhisdulyauthorizedpersonneltosearchwithout
warrantanyvehicle,railroadcars,vessel,aircraft,orpremisesusedinthebusinesstobeconductedunderthis
permitatanyandallhoursagreeabletothelawsofthestateofMaryland? ...........................
Yes No
D. Hastheapplicantever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yes,explainindetailonseparatepaper-listoense,court,date,etc.)
E. TheAnnotatedCodeofMaryland,AlcoholicBeveragesArticle,Section1-404titled“CompliancewithWorkers’CompensationAct”
requirestheevidenceofsuchcompliancepriortotheissuanceofanypermitbythisoce.Theapplicantherebyarms(complete
one):
a. ApplicantisnotanemployerrequiredtoprovidecoveragebytheMarylandWorkers’CompensationLaw;or
b. isanemployerrequiredtoprovideemployeecoveragebytheMarylandWorkers’CompensationLawandhassecuredsuch
coverage.Asevidenceofsuchcoverage,thefollowingissubmitted:
1. NameofInsuranceCompany: ______________________________________________________
2. PolicyorBinderNumber: __________________________________________________________
Section 3
(Tobecompletedonlyifyouanswered“No”toquestionFinSection 1)
Ownerofpremisesstatement: _________________________________________________________________________________
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businesstobeengagedinunderthepermitappliedforand(I/we)authorizetheComptrollerofMarylandandhis
dulyauthorizedpersonneltoinspectandsearchwithoutwarrantthepremisessodescribedatanyandallhours.
WITNESS(my/ours)hand(s)andseal(s)this ____________________________________________
_____________ __________________________
Month Day Year
WITNESS _________________________________________________________________________
__________________________________________________ (L.S.)
(Owner’sSignature)
WITNESS _________________________________________________________________________
__________________________________________________ (L.S.)
(Owner’sSignature)
COM-FED/RLS-10-7 Rev. 09/19
MARYLAND
FORM
10-7
APPLICATION FOR
NATIONAL FAMILY
BEER AND/OR WINE
EXHIBITION PERMIT
Section 4 (Fees)
A. PermitFee: ..................... $50.00
B. PrepaymentofTaxes*: Beer ....... $ ______________
Wine ....... $ ______________TotalTax ..... $_______________
Remitted herewith ........................................... $_______________
* Determinedbyestimatingthenumberofgallonsofcommerciallyproducedbeerorwinetobereceivedfromnon-Marylandlicensed
manufacturersorsuppliersandmultiplyingbythewinetaxrateof40¢pergallonorthebeertaxrateof9¢pergallon.
NOTE:
Within 30 days of the close of the event, Form 532-2 is to be completed and submitted to the Revenue Administration
Division.
Section 5 - All applicants must complete this section.
Adavit
Isolemnlydeclareandarmunderpenaltiesofperjurythatthecontentsoftheforegoingdocumentsaretrueandcorrectto
thebestofmyknowledge,information,andbelief.
SignatureofApplicant TypeorprintnameofApplicant
(Ifacorporation-thepresident,vicepresidentorsecretary/treasurer)
Title Date
If additional space is needed for any section, attach separate sheets.
Contact Information
ComptrollerofMaryland
FieldEnforcementDivision
Regulatory&LicensingSection
P.O.Box2999
Annapolis,Maryland21404-2999
410-260-7314or800-MD-TAXES
ATT@marylandtaxes.gov
www.marylandtaxes.gov
Page2
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10-7 - NATIONAL FAMILY BEER ANDOR WINE EXHIBITION (Comptroller of Maryland)

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Completed 14 August 2020

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