Fillable 19-3 MONTHLY REPORT OF VIOLATIONS/ SUSPENSIONS/ REVOCATIONS Form (Comptroller of Maryland)

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19-3 MONTHLY REPORT OF VIOLATIONS/ SUSPENSIONS/ REVOCATIONS Form (Comptroller of Maryland)

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COM-FED/RLS-19-3 Rev. 09/19
Form
19-3
MONTHLY REPORT
OF VIOLATIONS/
SUSPENSIONS/
REVOCATIONS
City or County: ______________________________ Month of: ____________________ Year: ________
City/County License #: _________________ Central Registration #: _________________ Class of License: _________________
Corporate Name: ________________________________________ Trade As Name: ___________________________________
Address of Licensed Premises: __________________________________________________________ Zip-Code:____________
Licensee 1: ________________________ Licensee 2: ________________________ Licensee 3: __________________________
VIOLATION # VIOLATION TYPE DISPOSITION & PENALTY
____________ _____________________________ _______________________________________________________
____________ _____________________________ _______________________________________________________
Date of Hearing: ___________________ Remarks: ___________________________________________________________
City/County License #: _________________ Central Registration #: _________________ Class of License: _________________
Corporate Name: ________________________________________ Trade As Name: ___________________________________
Address of Licensed Premises: __________________________________________________________ Zip-Code:____________
Licensee 1: ________________________ Licensee 2: ________________________ Licensee 3: __________________________
VIOLATION # VIOLATION TYPE DISPOSITION & PENALTY
____________ _____________________________ _______________________________________________________
____________ _____________________________ _______________________________________________________
Date of Hearing: ___________________ Remarks: ___________________________________________________________
City/County License #: _________________ Central Registration #: _________________ Class of License: _________________
Corporate Name: ________________________________________ Trade As Name: ___________________________________
Address of Licensed Premises: __________________________________________________________ Zip-Code:____________
Licensee 1: ________________________ Licensee 2: ________________________ Licensee 3: __________________________
VIOLATION # VIOLATION TYPE DISPOSITION & PENALTY
____________ _____________________________ _______________________________________________________
____________ _____________________________ _______________________________________________________
Date of Hearing: ___________________ Remarks: ___________________________________________________________
Page _____ of _____
COM-FED/RLS-19-3 Rev. 09/19
Form
19-3
MONTHLY REPORT
OF VIOLATIONS/
SUSPENSIONS/
REVOCATIONS
Instructions for completing Form COM-FED/RLS-19-3
1. Usethedrop-downtollinthenameofthecityorcounty,thecounty/citycode,andmonth,andtheyear
covered by the report.
NOTE: List each licensed premises separately for which a report of a violation(s), suspension(s),
or revocation(s) is made.
2. Inboxedarea,listlicensenumber,centralregistrationnumber(sameassalestax number),class
oflicense,corporatename(if any),tradeasname,addressandzip-codeoflicensedpremisesand
names of all licensees appearing on license.
3. Enter the violation # and violation type that applies to this licensed premises. If appropriate violation is
notlisted,enterviolation#47andentertheviolationtype.DescribethedispositionbeforetheLiquorBoard
andthepenaltyimposedbytheBoard.
4. ListthedateofthehearingbeforetheLiquorBoard,orthedate“NoContest”letterwasaccepted.Add
any remarks you wish to make.
5. Follow the same format listed above for each additional licensed premises. Attach additional sheets as
needed.
Comptroller of
Maryland
Field Enforcement Division
Regulatory &
Licensing Section
P.O.Box2999
Annapolis,MD21404-2999
410-260-7314or800-MD-TAXES
ATT@
marylandtaxes.gov
www.marylandtaxes.gov
After Hours
Age of Employee
BD7License
Beer,Wine,andLiquor–Cafeteria
Class License
ContentsTamperingorRells
DispensingofLiquor
Display of Licenses
FailuretoCooperate(Board/Police)
False Statement
Gambling on Premises
Illegal Conduct
Intoxicated Server
Keg Registration
LateFiling–Renewal
License Compliance Check
Minor Conducted Sale
NoAlcoholAwarenessCerticate
No Trader’s License
Noise-Disturbance of Neighborhood
Open Container
Open and Operate Tavern all Times
Outdoor Advertising
Outdoor Café
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
Ownership & Operation
Patrons on Unlicensed Premise
Prohibited Hours
Prohibited Practices
PublicWelfareorNuisance
PurchasefromOtherthanWholesalers
Ratio Violation or Late Ratio Report
Records,Reports,Invoices
RellBottle
RelationshipwithWholesaler
Revocation or Suspension
SaleofAlcoholicBeveragetoaMinor
Sale to Intoxicated Person
SaleofAlcoholWithoutaLicense
Sanitation & Safety
Storage of Alcohol
Trade Name Violation
Unapproved Source
UnauthorizedEntertainment
Underage Possession
Vacation of Premises
Violation Restriction of License
Other Violations
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
Violation # Violation Type Violation # Violation Type
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19-3 MONTHLY REPORT OF VIOLATIONS SUSPENSIONS REVOCATIONS Form (Comptroller of Maryland)

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Completed 14 August 2020

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