Fillable APPLICATION FOR SUBSTITUTE LICENSEE ALCOHOLIC BEVERAGE TALBOT COUNTY 2013

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APPLICATION FOR SUBSTITUTE LICENSEE ALCOHOLIC BEVERAGE TALBOT COUNTY 2013

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  • 11 check-boxes
  • 76 other fields

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U.S.A. forms for Talbot County Government

BROWSE TALBOT COUNTY GOVERNMENT (MD) FORMS

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Page 1 of 6
Application for Substitute Licensee
–
Talbot County
Updated: March 13, 2013
APPLICATION FOR SUBSTITUTE LICENSEE
ALCOHOLIC BEVERAGE LICENSE
TALBOT COUNTY
Refer to 11-12.C(2) Addition, deletion or substitution of license holders
Article 2. Alcoholic Beverages, The Talbot County Code
Check One:
Name of (check one) ____ Corporation, ____ LLC, ____ Partnership, _____ Club or
____Association (Incorporated or Unincorporated):
Business Address for Principal Place of Business:
Business Telephone Number
Names and Address of Substitute Applicant (Type or Print):
______________________________________________________________________________
Name
______________________________________________________________________________
Address
______________________________________________________________________________
Home telephone Cell Phone
PRESIDENT OR VICE-PRESIDENT
* Applicants and Presidents or __________________________________
Vice-Presidents must sign on opposite President or Vice President
Lines.
__________________________________
Applicant (Substitute Licensee)
Page 2 of 6
Application for Substitute Licensee
–
Talbot County
Updated: March 13, 2013
1. I hereby make application to Substitute for:________________________________________
(Name of Licensee to be removed)
Reason for substitution: _______________________________________________________
2. Name of Substitute Applicant:
___________________________________________________________________________
3. Address of Applicant: Years of Residency:___________________
____________________________________________________ / _____________________
County
4. Are you a citizen of the United States? ___Yes ___ No
5. Are you over 21 years of age?___ Yes ___No
6. If naturalized, when and where? ________________________________________________
7. Place of birth: _________________________________ /_________________________
City/County State
8. Have you ever been convicted of a felony, misdemeanor involving moral turpitude, been
adjudged guilty of violating the laws governing the sale of alcohol beverages, controlled
dangerous substances, gambling in Maryland or any other state in the United States or foreign
country? __________. If you answered yes, give details:
______________________________________________________________________________
9. What is your pecuniary interest in, employment relationship with, or nature of you
relationship to include the authority to act on behalf of the entity seeking the license.
______________________________________________________________________________
10. Have you ever had a license for the sale of an alcoholic beverage (a) Suspended or (b)
Revoked? _______. If you answered yes, give details:
______________________________________________________________________________
11. Are you financially interested in any other alcoholic beverage business or license in Talbot
County? _______. If you answered yes, give details:
______________________________________________________________________________
12. Have you ever held a license for the sale of alcoholic beverages and, if so, in what state and
at what location? _______________________________________________________________
13. Will you convey or grant any such interest to any manufacturer, brewer, distiller or
wholesaler at the time of making this application? _____________________________________
14. If granted a license will you incur any indebtedness or other financial obligation, directly or
indirectly, to any manufacturer, brewer, distiller or wholesaler other than for the purchase of
alcoholic beverages? ____________________________________________________________
Page 3 of 6
Application for Substitute Licensee
–
Talbot County
Updated: March 13, 2013
15. If granted a license will you conform to all law and regulations relating to the business in
which you proposed to engage? ____________________________________________________
________________________________________________
Signature of Applicant
STATE OF MARYLAND, TALBOT COUNTY, TO WIT:
THIS CERTIFIES, That on this ____ day of ________________, 20__, before the
subscriber, a Notary Public in and for _______________________________________________
(Town or County)
personally appeared _______________________________________________, the applicant in
the foregoing application, and made oath in due form of law that the statements therein are true
to the best of his knowledge and belief.
WITNESS my hand and Notarial seal.
____________________________________
Notary Public
My Commission Expires: ______________
(Seal)
Owner’s Consent for Substitute Licensee and to Search and Seizure
Talbot County Code, § 11-11 (A) requires that the renewal application be accompanied by a
statement, signed by the owner of the premises, consenting to: (1) renewal of the license, and (2)
search and seizure as in the case of the original application. A statement of consent shall not be
required if the owner has previously signed such a statement in connection with an original
application or previous renewal application giving consent for the term of the owner’s lease with
the applicant (check one):
THE APPLICANT HEREBY CERTIFIES THAT:
1. The owner of the premises has previously signed such a statement in connection
with an original application or previous renewal application giving consent to issuance of
an alcoholic beverage license, in the same license Class as this Application, for the
premises for the term of the owner’s lease with the Applicant;
Or,
2. The undersigned owner of the premises upon which the business it is to be
conducted, assents to the granting of the substitute licensee applied for and authorizes the
Comptroller of the State of Maryland, his duly authorized deputies, inspectors and clerks,
the Talbot County Board of Liquor License Commissioners, its duly authorized agents
and employees, any Talbot County Alcoholic Beverages Inspector, deputy, or assistant,
any peace officer of Talbot County and any peace officer of any incorporated
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Page 4 of 6
Application for Substitute Licensee
–
Talbot County
Updated: March 13, 2013
municipality in which the business is to be conducted to inspect and search, without
warrant, the premises upon which the business is to be conducted, and any and all parts of
the building in which the business is to be conducted, at any and all hours. This also
acknowledges that any evidence discovered during any lawful inspection of the licensed
buildings or premises shall be admissible in any prosecution for violation of Chapter 11,
Talbot County Code, and shall be admissible in any hearing for revocation, suspension,
or restriction of the license of the person, firm, corporation or association who has
obtained a license to sell alcoholic beverages in such building or premises. Talbot County
Code § 11-9 (N)
SIGNED BY OWNER ONLY IF BOX 2 ABOVE
IS CHECKED
Witness: OWNER:
__________________________ ___________________________________(SEAL)
___________________________Date:__________
Printed name
THE UNDERSIGNED, INDIVIDUALLY, JOINTLY, AND SEVERALLY, DO SOLEMNLY
DECLARE AND AFFIRM UNDER PENALTIES OF PERJURY THAT THE CONTENTS OF
THE FOREGOING SUBSTITUTE LICENSEE APPLICATION ARE TRUE AND CORRECT.
SIGNED BY EACH LICENSE HOLDER LISTED ABOVE
AND SIGNATURE WITNESSED
W
ITNESS
: I
NDIVIDUAL
A
PPLICANT
____________________________ ___________________________________(SEAL)
____________________________ ___________________________________(SEAL)
SIGNED BY REPRESENTATIVE OF THE ENTITY AND
SIGNATURE ATTESTED
A
TTEST
: _________________________________________
[
NAME OF ENTITY
]
____________________________ ___________________________________(SEAL)
B
Y
:
(
SIGNATURE
)
P
RINTED NAME
_____________________________
T
ITLE
:
____________________________________
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Page 5 of 6
Application for Substitute Licensee
–
Talbot County
Updated: March 13, 2013
County of _________________
State of ___________________
BEFORE ME, THE UNDERSIGNED, a Notary Public in and for the State and County
aforesaid, on this _________ day of __________________ 20____, personally appeared
________________________________________________________________, known to me,
(LIST NAME OF OWNER HERE)
or satisfactorily proven to be the individual whose name is subscribed above, who executed the
foregoing Application for Substitute of Licensee of Talbot County Alcoholic Beverages License
for the purposes therein contained, and made oath and due form of law that the contents of the
foregoing are true and correct.
___________________________________
NOTARY PUBLIC
My commission expires: ______________
(Seal)
County of _________________
State of ___________________
BEFORE ME, THE UNDERSIGNED, a Notary Public in and for the State and County
aforesaid, on this _________ day of __________________ 20____, personally appeared
___________________________________________________________________, known to
(
LIST NAME OF INDIVIDUAL SIGNING AS REPRESENTATIVE OF THE ENTITY/CORPORATION
)
me, or satisfactorily proven, to be the individual whose name is subscribed above, and, in his/her
representative capacity acting by and on behalf of the Entity identified above who, being
authorized so to do, executed the foregoing Application for Substitute of Licensee of Talbot
County Alcoholic Beverage License for the purposes therein contained, by signing the name of
the Entity by himself/herself as ____________________________________________________
[title of corporate officer or other description of legal capacity],
and who made oath and due form of law that the contents of the foregoing Application for
Renewal of Talbot County Alcoholic Beverages License are true and correct.
___________________________________
NOTARY PUBLIC
My commission expires: ______________
(Seal)
Page 6 of 6
Application for Substitute Licensee
–
Talbot County
Updated: March 13, 2013
SUBSTITUTE LICENSEE - ATTACHMENT
Date:___________________________
This certifies that (
Individual’s Name to be removed from license
)_______________________________
is no longer employed with (
Name of Company
)_________________________________________
and is to be removed as a licensee on the Liquor License for this location.
_______________________________________
Signature
I, (
Individual’s Name to be removed from license
)____________________________________________
hereby certify that the above information is true and correct, and request that my name be
removed from the Liquor License of (
Name of Company
)__________________________________.
_______________________________________ ________________________
Signature Date
STATE OF MARYLAND, TALBOT COUNTY, TO WIT:
THIS CERTIFIES, That on this ______day of ___________________, 20_____, before
the subscriber, a Notary Public in and for ____________________________________________
(Town or County)
personally appeared ______________________________________________, and made oath in
due form of law that the statements therein are true to the best of her knowledge and belief.
WITNESS my hand and Notarial Seal.
____________________________________
Notary Public
My Commission Expires:_______________
(Seal)
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APPLICATION FOR SUBSTITUTE LICENSEE ALCOHOLIC BEVERAGE TALBOT COUNTY 2013

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Completed 20 December 2019

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