Fillable Form 367: MANUFACTURERS AND WHOLESALERS LICENSES APPLICATION FOR (Comptroller of Maryland)

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Form 367: MANUFACTURERS AND WHOLESALERS LICENSES APPLICATION FOR (Comptroller of Maryland)

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COM-FED/RLS-367 Rev. 09/19
New Renewal ___________________________ Date: _________________________
License #
For the use of: (Check one)
An individual Partnership Corporation Limited Liability Co.
MARYLAND
FORM
367
APPLICATION FOR
MANUFACTURER’S
AND WHOLESALER’S
LICENSES
CHECK CLASS OF LICENSE REQUIRED - USE A SEPARATE APPLICATION FOR EACH LICENSE
Class 1 Distillery Annual Fee $2,000.00
Class 2 Rectifying Annual Fee $600.00 *
Class 3 Winery Annual Fee $750.00 *
Class 4 Limited Winery Annual Fee $200.00
Class 5 Brewery Annual Fee $1,500.00 *
Class 6 Pub-Brewery Annual Fee $500.00
Class 7 Micro-Brewery Annual Fee $500.00
Class 8 Farm Brewery Annual Fee $200.00
Class 9 Limited Distillery Annual Fee $500.00
* If you are going to sell to retailers, you will also need a
Wholesaler’s License of the proper class.
Class 1 Beer, Wine & 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
• $200.00 non-refundable application fee must be submitted with any initial license application.
• Upon approval of your initial application, you will be notied of the appropriate prorated license fee to submit.
• Wholesale licensees of any class using this form to apply for wholesale licenses for additional locations need not submit the $200.00
non-refundable application fee.
• Application is made by the undersigned under the provisions of the Annotated Code of Maryland, Alcoholic Beverages Article for the
Class of License as checked above, and the applicant(s) submit(s) and certify(ies) to the following information required by law.
1. Applicants *
(1) (2)
(3)
Name
Residence
Cell Phone
Date of Birth
Place of Birth
Social Security Number **
Qualifying Maryland
Resident? ***
Yes No Yes No Yes No
MD Resident since
* A license is issued to three applicants for the use of the company. If less than three applicants exist, then a license may be issued to
those ocers/members/partners. In such case, a letter so certifying must be submitted.
** The disclosure of applicant’s Social Security Number is mandatory and will be used for background investigations, including
a criminal history records check, pursuant to the Annotated Code of Maryland, Alcoholic Beverages Article.
*** At least one applicant must be a voter and taxpayer in Maryland presently and for the two immediately preceding years. In case of
partnership, all individuals must meet this requirement.
Wholesaler’s Licenses
Manufacturer’s Licenses
2. Company name and trade name __________________________________________________________________________
3. a. Location of proposed licensed premises (complete address, include nine digit ZIP code) _____________________________
_____________________________________________________________________________________________________
b. Additional location (if applicable) _________________________________________________________________________
COM-FED/RLS-367 Rev. 09/19
MARYLAND
FORM
367
APPLICATION FOR
MANUFACTURER’S
AND WHOLESALER’S
LICENSES
Page 2
4. Description of premises to be covered under license applied for (lot, type, size and construction of building) ______________
_____________________________________________________________________________________________________
5. Mailing Address (Street) __________________________________________________________________________________
(City, State, Zip Code) ___________________________________________________________________________________
6. Business phone number(s) _____________________________________________ Fax Number __________________________
E-mail address: ________________________________________________________________________________________
a. Date business began __________________________________________________________________________________
b. Type of accounting period (calendar yr, scal yr, etc.) ________________________ Month FY begins ____________________
c. If corporation or limited liability company, date chartered _________________________ State ______________________
d. Federal Employer Identication Number ___________________________________________________________________
7. Name and address of the owner of premises _________________________________________________________________
8. The applicants are presently the holders of the following alcoholic beverages licenses or permits issued by the state of
Maryland, any other state or jurisdiction, or the United States government (if more space is needed, attach additional sheet).
Issuing Authority Type Expiration Date Number
9. The applicants have previously held the following alcoholic beverage licenses or permits: _____________________________
__________________________________________________________________________________________________________________
10. The applicants have applications pending for the following alcoholic beverage licenses or permits: _________________________
_____________________________________________________________________________________________________
11. Class 5 Brewery - Rellable Container Permit
A Rellable Container permit authorizes the holder to sell draft beer for consumption o the licensed premises in a rellable
container that:
1. Has a capacity of not less than 32 ounces and not more than 128 ounces
2. The container shall:
a. Be saleable
b. Branded with an identifying mark of the license holder
c. Bear the federal health warning statement required for containers of
alcoholic beverages
under 27 C.F.P. 16.21
d. Display instructions for cleaning the container
e. Label stating cleaning the container is the responsibility of the consumer
f. Label stating contents of the container are perishable and should be refrigerated immediately and consumed within 48
hours after purchase
3. The hours of sale for a rellable container permit are the same as the hours for a guided tour, a
promotional event or other organized activity at the licensed premise.
4. A holder of a rellable container permit may rell only a rellable container that was branded by the permit holder.
The applicant would like to have the Rellable Container Permit option added to my Manufacturers License ....
Yes No
The applicant agrees to comply with the requirements for a Rellable Container .......................
Yes No
12. Please answer each of the following questions applicable to all individual applicants:
(attach explanation if “Yes” to (*) questions):
*a. Has any applicant ever been convicted of a felony by any state or federal court? ...................
Yes No
*b. Has any applicant ever 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
*c. Has any applicant ever been denied or had revoked an alcoholic beverage license or permit? ..........
Yes No
COM-FED/RLS-367 Rev. 09/19
Note: If President or Vice-President is one
of the applicants, he/she must sign both as
President/Vice-President and as applicant.
MARYLAND
FORM
367
APPLICATION FOR
MANUFACTURER’S
AND WHOLESALER’S
LICENSES
13. The Annotated Code of Maryland, Alcoholic Beverages Article, Section 1-404 titled “Compliance with Worker’s Compensation
Act” requires the evidence of such compliance prior to the issuance of any license by this oce. The applicant hereby arms
(complete one):
a. the applicant is not an employer required to provide coverage by the Maryland Workers’ Compensation Law; or,
b. the applicant is an employer required to provide employee coverage by the Maryland Workers’ Compensation Law and
has secured such coverage as evidenced by the certicate of compliance attached herewith; or
c. the applicant is an employer required to provide employee coverage by the Maryland Workers’ Compensation Law and
has secured such coverage. As evidence of such coverage, the following is submitted:
1. Name of Insurance Co. _________________________________________________________________________
2. Policy or Binder No. ____________________________________________________________________________
14. All applicants must complete this section
Consent
By signing this application, I hereby give permission and consent to the Comptroller of Maryland, its employees and agents, to conduct
an investigation and receive reports about my background, including a criminal history records check, for the purpose of determining
the accuracy of the statements made on this application for an alcoholic beverages license and my tness to receive such a license. I
further authorize any person, business entity, or governmental agency that may have relevant information to disclose the same to the
Comptroller of Maryland, its employees and agents.
Adavit
Also, by signing this application, I do solemnly declare and arm 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.
Print name(s) and address(es) of ocer(s): (Note: All ocers must be listed - attach separate sheet if necessary.)
Name Title Residence
Name Title Residence
Name Title Residence
Name Title Residence
Signature of President or Vice-President Signature of applicant Signature of applicant
Signature of applicant
*d. Has any applicant ever been convicted of a controlled dangerous substance oense which was committed
on or after January 1, 1991? ........................................................
Yes No
*e. Are any of the applicants pecuniarily interested in any other place of business with a retail alcoholic
beverage license issued or applied for? ................................................
Yes No
*f. Are any of the applicants’ immediate families pecuniarily interested in a retail license? ............... Yes No
g. Do the applicants agree to conform to all the laws, rules and regulations of the state of Maryland relating
to the business in which they propose to engage under this license? ............................
Yes No
h. Do the applicants agree that they will not furnish anything of value to a retail licensee except advertising
and related items provided by the Annotated Code of Maryland, Alcoholic Beverages Article and
regulations and bulletins issued by the Comptroller? .......................................
Yes No
i. Do the applicants authorize the Comptroller and his duly authorized personnel to search without warrant
any premise or vehicle used in the business to be conducted under this license at any and all hours
agreeable to the state of Maryland? ..................................................
Yes No
j. Do the applicants produce not more than 35,000 gallons of their own wine annually? (To be completed by
Class 6 Limited Winery wholesale applicants only). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes No
k. Do the applicants produce not more than 100,000 gallons of their own liquor annually? (To be completed
by Class 8 Liquor wholesale applicants only) .............................................
Yes No
l. Do the applicants produce not more that 45,000 barrels of own beer annually? (To be completed by Class
7 Micro Brewery Manufacturer’s applicants only) ..........................................
Yes No
Page 3
COM-FED/RLS-367 Rev. 09/19
MARYLAND
FORM
367
APPLICATION FOR
MANUFACTURER’S
AND WHOLESALER’S
LICENSES
This Section Must be Completed by the Owner of the Premises
15. 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 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 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 the foregoing document are true and
correct to the best of my knowledge, information and belief.
Signature Type or print name
Company Name and Title Date
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
Comptroller of Maryland
Field Enfo
rcement 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
Page 4
OFFICE USE ONLY
Check Number __________
Amount $ _____________
Deposit Date____________
Approved ______________
Date _________________
License # ______________
Stub # ________________
Date Issued ____________
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Completed 14 August 2020

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