COM-FED/RLS-384 Rev. 09/19
Date ______________________________
To the Comptroller of Maryland:
Application is made by the undersigned under the provisions of the Annotated Code of Maryland,
Alcoholic Beverage Article for the permit indicated above. The permit expires December 31st annually
regardless of the eective date. For event participation limitations, please refer to the Annotated Code
of Maryland, Alcoholic Beverages Article Sections: Winery O-Site 2-133; Distillery O-Site 2-132.2;
Brewery O-Site 2-130.
License name and/or trade name: ____________________________________________________
Mailing address: __________________________________________________________________
_____________________________________________________________________________
Business Phone Number:
_________________________
License Number: M
Federal Identication Number
Central Registration Number
1. Do the applicants agree to conform to all laws, rules, and regulations of the State of Maryland relating to the
business in which they propose to engage under this permit? ....................................
Yes No
2. Do the applicants agree to keep Owner of Premise form at license location for 3 years or until audited?. . . . . . .
Yes No
3. Do the holders of a Class 5 Brewery License or a Class 7 micro-Brewery License produce less than 3,000
barrels per year? ....................................................................
Yes No
If yes, you are a limited permit holder pursuant to the Annotated Code of Maryland, Alcoholic Beverages Article, Section 2-130.
4. Must be signed by a licensee.
The permit holder shall notify the Comptroller of the permit holder’s intention to attend an o-site event on Form 386,
Intent to Participate in an O-Site Event form. The permit holder is also required to notify the local licensing board of
the jurisdiction in which the Farmers Market or Non-prot Festival will be held.
For Distillery o-site permit holders only: while selling liquor or providing samples of liquor at an event, the permit holder shall have
present at least one individual who is certied by an approved alcohol awareness program.
Adavit
(I/We) do solemnly declare and arm under penalties of perjury that the contents of the foregoing document are true and
correct to the best of (my/our) knowledge, information, and belief.
Signature of Applicant Type or Print Name
Please note that term of this permit is one year and expires on December 31st annually, regardless of the eective date. At no time
will the Comptroller send out any notices for renewal, nor is there any renewal available for this permit. It is upon the initiative of
the applicant to reapply for any new permits upon the expiration of their current permit.
Oce Use Only
Permit # ______________
Permit Year ____________
Stub # _______________
Approved _____________
Date _________________
Check # ______________
Check Amount $ ________
Deposit 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.marylandtaxes.gov
____ - _________________
___________________
Winery O-Site Permit $100.00 Brewery O-Site Permit $100.00 Distillery O-Site Permit $250.00
__ - _____________
MARYLAND
FORM
384
APPLICATION FOR AN
OFF-SITE PERMIT
