Fillable 367-2 APPLICATION FOR AN ADDITIONAL LICENSE LOCATION MARYLAND (Comptroller of Maryland)

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367-2 APPLICATION FOR AN ADDITIONAL LICENSE LOCATION MARYLAND (Comptroller of Maryland)

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COM/FED/RLS-367-2 08/19
Statement of Owner of Premises Required in Connection with the Annotated Code of Maryland, Alcoholic Beverages Article
(I, We) hereby certify, that (I am, we are) the owner(s) of property known as ___________________________________________
_________________________________________________________________________________________________________
named in the foregoing application made to the Comptroller of Maryland under the Annotated Code of Maryland, Alcoholic Beverages
Article; that (I, we) assent to the granting of the license applied for, and that (I, we) hereby authorize the Comptroller of Maryland,
his duly authorized deputies, inspectors and clerks, the Board of License Commissioners of the county in which the place of business
is located, its duly authorized agents and employees, and any peace ocer of such county to inspect and search, without warrant, the
premises upon which the business is to be conducted, and any and all parts of the building(s) in which said business is to be conducted,
at any and all hours.
Witness (our/my) hand(s) and seal(s) this ____ day of ___________________ , _______
_______________________________________
Signature of Owner of Premise
STATE OF MARYLAND ______________________________ ss:
THIS CERTIFIES, That on the _______ day of ___________________ , _______ , before the subscriber, a __________________
of the State of Maryland, personally appeared ___________________________________________________________ and
acknowledged the execution of the foregoing statement to be _______ act.
_________________________________________________
Signature of Ocer/License Applicant
STATE OF MARYLAND ______________________________ ss:
THIS CERTIFIES, That on the _______ day of
_________________
, _______ , before the subscriber, a ____________________
of the State of Maryland, personally appeared __________________________________________________________________
_______________________________________________________________________________________________________
the applicant(s) named in the afore going application, and made oath in due form of law that the statements there are true to the
best of the applicant’s knowledge and belief.
WITNESS my hand and ocial seal
(Seal) ________________________________________________
This statement is to be attached to and made a part of the application of:
Name(s) of license applicant(s) License Number
Trade name
Present Address; Number and Street
City County State Zip Code
The BRANCH LOCATION location for which license is desired is known as:
Street Address
City County State Zip Code
Describe premises
Telephone Number Fax Number Email Address
MARYLAND
FORM
367-2
APPLICATION FOR AN
ADDITIONAL LICENSE
LOCATION
COM/FED/RLS-367-2 08/19
Third Party Checks
Adavit
I do solemnly declare and arm 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 Ocer Title
Federal Identication Number and/or Social Security Number Date
Licenses and Fees
Wholesaler’s License
Class 1 Beer, Wine and Liquor Annual Fee $2,000.00
Class 2 Wine and Liquor Annual Fee $1,750.00
Class 3 Beer and Wine Annual Fee $1,500.00
Class 4 Beer Annual Fee $1,250.00
Class 5 Wine Annual Fee $1,250.00
Class 6 Limited Wine Annual Fee $50.00
Class 7 Limited Beer Annual Fee $50.00
Class 8 Liquor Annual Fee $100.00
Contact Information
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
WITNESS my hand and ocial seal
(Seal) _________________________________________
Page 2
MARYLAND
FORM
367-2
APPLICATION FOR AN
ADDITIONAL LICENSE
LOCATION
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367-2 APPLICATION FOR AN ADDITIONAL LICENSE LOCATION MARYLAND (Comptroller of Maryland)

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Completed 14 August 2020

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