COM-FED/RLS 20-3A Rev. 09/19
MARYLAND
FORM
20-3A
APPLICATION FOR A
PRIVATE BULK SALE
PERMIT
Oce Use Only
Number _______________
Permit Year _____________
Stub Number ___________
Approved ______________
Date __________________
Check Number __________
Check Amount $ ________
Deposit Date____________
Application is made by the undersigned under the provisions of the Annotated Code of Maryland,
Alcoholic Beverages Article for a Private Bulk Sale Permit and the applicant(s) submit(s) and
certify(ies) to the following information.
Fee for Private Bulk Sale Permit - $25.00
(Make check payable to “Comptroller of Maryland”)
Section 1 - All applicants must complete this section. Type or print clearly.
A. Permit is to be issued in the name of ____________________________________________
Applicant’s Full Name
B. Whose telephone number is ______________________ Fax _______________________
C. E-mail address _____________________________________________________________
D. Whose address is ______________________________________ ________________________ _____ _______________
Street and Number City State 9-Digit Zip Code
E. Applicant’s birth date ________________________________________________________
MM/DD/YYYY
F. Applicant’s Social Security No. ________ - ____ - ________
Section 2 - Applicant certies to the following:
A. All alcoholic beverages to be sold have been legally acquired and transported into Maryland, in accordance
with the Annotated Code of Maryland, Alcoholic Beverages Article.
YES NO
B. All alcoholic beverages intended for sale under a Private Bulk Sale Permit are owned by the applicant.
YES NO
C. Attached herewith is a complete inventory of alcoholic beverages to be sold under the Private Bulk Sale
Permit. (Indicate on separate sheet the brand name, bottle size and number of bottles.)
YES NO
D. Applicant understands that a maximum of two Private Bulk Sale Permits may be obtained in a calendar year.
YES NO
Section 3
Identify who will be the seller of the alcoholic beverages identied in the inventory attached. (Check one)
Sale will be made by the individual permit applicant to the buyer.
Sale will be made by an unlicensed agent or auction company acting on behalf of the permit applicant.
Provide name and address of entity:
Entity Name
Street Address City State 9-Digit Zip Code
