COM-FED/RLS-370-5 09/19
Maryland
Form
370-5
SOLICITOR’S PERMIT
APPLICATION
1. Does the applicant agree to conform to all the laws, rules, and regulations of the state of Maryland relating
to the business in which he proposes to engage under this permit? ................................ Yes No
2. Does the applicant agree that he or she will not furnish anything of value to a retail licensee except advertising
and related items provided by the Alcoholic Beverages Article of the Annotated Code of Maryland and
regulations and bulletins issued by the Comptroller? ...........................................
Yes No
3. Are you or any member of your immediate family listed as a retail license applicant or employed by a retail
licensee, or do you have a direct or indirect nancial interest in such an establishment? ................. Yes No
If your answer to this question is yes, attach explanation along with statement you will not solicit this account.
4. Has the applicant ever been convicted of a felony by any state or federal court? .......................
Yes No
If your answer to this question is yes, explain in detail below.
5. Has the applicant 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 your answer to this question is yes, explain in detail below.
Name Oense Court Date
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Adavit
I do solemnly declare and arm under the penalties of perjury that the contents of the foregoing document are true and
correct to the best of my knowledge, information and belief.
Signature Date
Third Party Checks
I do solemnly declare and arm 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 Ocer Title
Federal Identication Number and/or Social Security Number Date
Important
The Solicitor Permit fee is $50.00. Your check made payable to “Comptroller of Maryland” should be remitted with your application.
Mail or submit your application to the Regulatory & Licensing Section in the Annapolis oce.
An application must be submitted and a permit issued prior to engaging in any activity authorized by a Solicitor Permit. The
permit must be physically carried on your person at all times while engaging in the activity.
It is preferable that applicants mail their application to the address below at least 10 days in advance of need.
Solicitor’s Permits Expire October 31 Annually
Page 2
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
