Fillable Form 355: PERMIT APPLICATION NON-PROFIT FESTIVAL CATEGORIES (Select (Comptroller of Maryland)

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Form 355: PERMIT APPLICATION NON-PROFIT FESTIVAL CATEGORIES (Select (Comptroller of Maryland)

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COM-FED/RLS-355 Rev. 09/19
Form
355
NON-PROFIT FESTIVAL
PERMIT APPLICATION
Oce Use Only
Approved ______________
Date __________________
Permit Number __________
Permit Year _____________
Stub Number ___________
To the Comptroller of Maryland,
Application is made by the undersigned under the provisions of Annotated Code of
Maryland, Alcoholic Beverages Article for the permit indicated above. This application shall
be led with the oce of the Comptroller not less than 30 days prior to Non-Prot Festival.
Permit authorizes permit holder to conduct a non-prot festival for at least 1 day and not
more than 3 consecutive days.
CATEGORIES (Select One)
One Product Category - $100
Two Product Categories - $150
Three Product Categories - $200
1. Name of Non-Prot organization: ______________________________________________
2. Mailing address: __________________________________________________________
________________________________________________________________________
3. Business Telephone no.: ____________________________________________________
4. Federal tax identication number: _____________________________________________
5. Attach a copy of your 501(c) determination letter.
6. The primary purpose of this is to promote Maryland beer, liquor or wines ............................ YES NO
7. Provide details of non-prot festival, check all that apply
Beer Wine Liquor: __________________________________
______________________________________________________________________________________________________
8. Location: _______________________________________________________________________________________________
City/County Code ________________________________
Non-Prot Festival dates: _____________________________________ Hours of Operation: ____________________________
9. Does applicant agree to conform to all laws, rules and regulations of the State of Maryland related to the
actions and business activities authorized under this permit? .....................................
YES NO
10. I agree that at all times during the Non-Prot Festival the permit holder shall have present at all times at least
two agents, one of whom may be the permit holder, who are certied by an approved Alcohol Awareness Program .
YES NO
1. Name ____________________________________________________ Phone Number _____________________________
Name of program ____________________________________________________________________________________
2. Name ____________________________________________________ Phone Number _____________________________
Name of program ____________________________________________________________________________________
11. Submit with this application to the Oce of the Comptroller a list of all o-site permit holders who will attend
this Non-Prot Festival.
PLEASE NOTE:
YOU ARE REQUIRED TO NOTIFY THE LOCAL LICENSING BOARD OF THE JURISDICTION IN WHICH THE
FESTIVAL WILL BE HELD THAT THE FESTIVAL PERMIT HAS BEEN ISSUED.
12. Must be signed by an ocer of non-prot.
AFFIDAVIT
I do solemnly declare and arm under the penalties of perjury that the contents of this document are true and correct to the best of
my knowledge, information, and belief.
Signature Printed Name
COM-FED/RLS-355 Rev. 09/19
Form
355
NON-PROFIT FESTIVAL
PERMIT APPLICATION
13. This section must be completed by the authorized representative of the Non-Prot Festival.
CERTIFICATION
I hereby certify that I am the authorized representative of the Festival stated in this Permit located at
__________________________________________ , __________________________________________ , County/City, Maryland,
and that I assent to the granting of this Permit to the retail licensee stated on this application, and that I authorize the Comptroller
of Maryland, his duly authorized deputies, inspectors and clerks, the Board of License Commissioners of the jurisdiction in which the
Non-Prot Festival is located, its duly authorized agents and employees, and any peace ocer of such jurisdiction to inspect and
search, without warrant, the premises upon which the actions and activities under this Permit are to be conducted, at any and all
hours.
14. This section must be completed by the owner of the premises where the event will take place.
Statement of owner of premises required in connection with Alcoholic Beverages Law of Maryland: I/we hereby certify that I am/
we are the owner(s) of the property known as _______________________________________________________________
____________________________________________________________________________________________________
named in the foregoing application made to the Comptroller of Maryland under the Alcoholic Beverages Law of Maryland; that
I/we assent to the granting of the permit 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 jurisdiction in which the place of business
is located, its duly authorized agents and employees and any peace ocer of such jurisdiction 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 said business
is to be conducted at any and all hours.
Adavit
I do solemnly declare and arm under the penalties of perjury that the contents of this foregoing document are true and correct
to the best of my knowledge, information, and belief.
_________________________________________________ __________________________________________________
Signature of owner, partner or corporate ocer Type or print name of owner, partner or corporate ocer
_________________________________________________ __________________________________________________
Title Date
CONTACT INFORMATION:
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.maryalndtaxes.gov
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Form 355: PERMIT APPLICATION NON-PROFIT FESTIVAL CATEGORIES (Select (Comptroller of Maryland)

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Completed 14 August 2020

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