Revised Feb. 21, 2020 2
Pursuant to the authorization of Section 17. 20. 100 (Uniform Fire Code) of the Charter and Code of the City of
Annapolis. Visit www.crowdmanagers.com/training for more information.
Does the assembly have a certified crowd manager? Yes N/A
If no, please explain
Alcoholic Beverages will be:
Provided by guests (bringing their own bottles).
Provided to guests, at no charge.
Provided to guests, for which they will be charged, either by a ticket, admission charge, or at a cash bar.
*For Clubs and non-profit organizations with a Special Class C One-Day Liquor License, state wide caterers license holders or
current license holders with a temporary extension of premises if directly adjacent to licensed premises.
I, as a legally authorized representative of the Applicant, hereby certify that the above information is true and correct to
the best of my knowledge, information and belief, and that I have read and understand the statements made on this
If any signed statement, report, affidavit, or oath, required under any of the provisions of Article 2B, Section 198 of the
Annotated Code of Maryland, shall contain any false statement, the offender shall be deemed guilty of perjury, and upon
conviction thereof, shall be subject to the penalties provided by law for that crime.
Authorized Representative Name
Authorized Representative Signature
Signature of witness
Received & content noted
Dept. Director Date
On behalf of the Alcoholic Beverage Control Board on this day of ,
Deputy City Clerk
Please feel free to contact the City Clerk’s Office at 410-263-7942.