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Revised Dec. 8, 2020
1. The Licensees are ci
tizens of the United States. True False
2. Has each Licensee been a resident of the City of Annapolis and/or Anne Arundel County, a real property taxpayer of
the City of Annapolis and/or Anne Arundel County, and a City of Annapolis and/or Anne Arundel County voter for
more than two (2) years prior to filing this application? Licensee one must meet these requirements.
Licensee 1. Yes No 2. Yes No 3. Yes No
3. Workmen's Compensation Binder or Policy number
4. Contact Person for Establishment
Cell Phone Email Address
5. Premises description Lot size Size and type of construction and building or area applied for:
6. Name of the owner of Premises described above
7. The Licensees have never been convicted of a felony. True False
8. The Licensees have never been adjudged guilty of violating the laws governing the sale of Alcoholic Beverages or
for the prevention of gambling in the State of Maryland. True False
If false, give Licensee names, dates and offenses.
9. The Licensees have a pecuniary interest in the business to be conducted under the License. True False
10. The Licensees have not had a License for the sale of Alcoholic Beverages revoked. True False
12. The Licensees ha
ve never been adjudged guilty of any offense against the laws of the State of Maryland or United
States. True False
13. Have the Licensees ever held a License for the sale of Alcoholic Beverages? True False
If yes, in what state and at what location therein?
14. No person except the Licensees is in any way pecuniary interested in the License applied for or in the business to be
conducted thereunder during the continuance of the License, if issued. True False
a. What financial interest does each of the Licensees have in the business/applicant?
Percentage for Licensee: 1. 2. 3.
b. If any persons other than the Licensees are pecuniary interested in the business/applicant, please provide
names, title or position in business/applicant, percentage of interest, shares of stock or membership (as
applicable), and a statement if each such person holds an interest in any other Alcoholic Beverage License.
No manufacturer, brewer, distiller, or wholesaler, directly or indirectly, has any financial interest in the Premises, the
applicant, or the business of the applicant and the Licensees, and the applicant and the Licensees shall not convey
or grant to any manufacturer, brewer, distiller or wholesaler any such interest, except as otherwise permitted by
the Alcoholic Beverages Article; and the applicant and the Licensees do not have, at the time of making this
application, any indebtedness or other financial obligation and shall not incur any such indebtedness or other
financial obligation, directly or indirectly, to any manufacturer, brewer, distiller or wholesaler other than for the
purchase of Alcoholic Beverages.
16. The applic
ant and the Licensees shall, if granted a License, conform to all laws and regulations relating to the
business in which the applicant proposes to engage. True False
The Licensees are not pecuniary interested in any other place of business in the City of Annapolis or Anne Arundel
County where, or for which, a License has been applied for, granted or issued under Alcoholic Beverages Article,
except as otherwise permitted by the Alcoholic Beverages Article.