Fillable Substitution or Deletion of Licensee Alcoholic Beverage Control (City of Annapolis)

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Substitution or Deletion of Licensee Alcoholic Beverage Control (City of Annapolis)

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BROWSE CITY OF ANNAPOLIS (MD) FORMS

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Rev. 12/30/2015
Alcoholic Beverage Control Board
Substitution or Deletion of Licensee
Filing Fee: $225.00 payable to the City of Annapolis.
Application Due: Thirty (30) days in advance of hearing before the Board.
1. Any entity holding an Alcoholic Beverage License may, during the License year, substitute any or all of its officers or
employees named as Licensees pursuant to Section 2.01(J) of the Alcoholic Beverage Control Board
Rules and
Regulations if the Licensee to be substituted or deleted is deceased, retired, removed from office or employment with
the entity, or no longer holds office or employment with the entity.
2. Prior to any substitution or deletion of a Licensee, the following documents (one original and six copies) are
required to be submitted to the Deputy City Clerk:
a. Application for Substitution of Licensee.
b. Affidavit of Corporate Officer for Substitution or Deletion of Licensee.
c. Financial Information Form (if adding a new officer).
d. Corporate Resolution or Corporate Minutes evidencing the change of officer/employee.
e. Shareholders Certificate or Member Percentage, as applicable for a corporation or LLC.
3. If the Licensee being substituted or deleted is the qualifying Licensee under Section 2.01 of the Alcoholic Beverage
Control Board
Rules and Regulations, a new qualifying Licensee shall be appointed and shall:
a. For the two (2) years preceding the date of the substitution or deletion, be a resident, real property taxpayer
and registered voter of the City of Annapolis or Anne Arundel County, Maryland; and
b. During the term of the License, continue to be a resident, real property taxpayer and registered voter of the
City of Annapolis or Anne Arundel County, Maryland.
Any terms used in this form, which are not otherwise defined, shall have the meanings indicated in the Alcoholic Beverage
Control Board (ABCB or Board)
Rules and Regulations.
City of Annapolis
Office of the City Clerk
160 Duke of Gloucester Street
Annapolis, MD 21401
DepClerk@annapolis.gov • 410-263-7942 • Fax 410-280-1853 • TDD use MD Relay or 711 • www.annapolis.gov
Page 1 of 3
Rev. 12/30/2015
Alcoholic Beverage Control Board
Substitution of Licensee Application
Entity Legal Name
Address of Licensed Premises
Licensee being removed:
Name
New Licensee to be added to License:
Name
Address How long?
Date of birth Place of birth
Phone(s) Email address
1. Have you been a resident, taxpayer and registered voter of the City of Annapolis or Anne Arundel County, Maryland
for two (2) years preceding the filing of this application? Yes No
2. Do you have a financial interest in the business of the Licensed Premises? Yes No
3. Will you be participating in the daily management of the Licensed Premises? Yes No
4. Do you hold office in the entity completing this application? Yes No
5. Have you ever been convicted of a felony? Yes No
6. Are you a citizen of the United States? Yes No
7. Have you ever been adjudged guilty of violating the laws governing the sale of Alcoholic Beverages or for the
prevention of gambling in the State of Maryland? Yes No
8. Have you ever been adjudged guilty of any offense against the laws of the State or of the United States?
If yes, state details below. Yes No
9. What is your pecuniary interest in the business to be conducted under this License? State percentage
10. Do you have a pecuniary interest 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 this article, except as otherwise
permitted in by Article 2B? Yes No
11. Have you had a license for the sale of alcoholic beverages revoked? Yes No
City of Annapolis
Office of the City Clerk
163 Duke of Gloucester Street
Annapolis, MD 21401-2028
DepClerk@annapolis.gov • 410-263-7942 • Fax 410-280-1853 • TDD use MD Relay or 711 • www.annapolis.gov
Page 2 of 3
Rev. 12/30/2015
12. Have you ever held a License for the sale of Alcoholic Beverages, and if so, in what state and at what location
therein? If yes, state details below. Yes No
13. If the substitution is granted, will you conform to all laws and regulations relating to the business in which you
propose to engage? Yes No
14. List the names and titles of the officers of the entity submitting this application.
Name
Title
I HEREBY CERTIFY, on this day of , , under penalties of perjury, that
the matters and facts set forth above are true and correct; and that I hereby authorize the City of Annapolis and Annapolis
Police Department, its employees, agents and officers to release unto the City Clerk and personnel employed in that
office any and all criminal background records that may exist or come into the possession of the City of Annapolis or the
Annapolis Police Department for purposes of processing this application.
Signature of New Licensee
STATE OF MARYLAND, ANNE ARUNDEL COUNTY, to wit:
I HEREBY CERTIFY, on this day of , , before me, the subscriber, a
Notary Public of the State and County aforesaid, personally appeared the New Licensee named above and made oath in
due form of law that the matters and facts set forth above are true to the best of his/her knowledge, information and belief.
WITNESS my hand and Notary Seal.
Notary Public My Commission expires
FOR OFFICE USE ONLY
Approved by the Alcoholic Beverage Control Board
Page 3 of 3
Rev. 12/30/2015
Affidavit of Corporate Officer for Substitution or Deletion of Licensee
Corporate/legal name of the Premises
Contact Person
Work Phone # Contact/Cell Phone #
E-mail Address
Premises Address
STATE OF MARYLAND, COUNTY OF ANNE ARUNDEL, to wit:
I HEREBY CERTIFY, on this day of , , before me, the subscriber, a Notary
Public of the State of Maryland, in and for the county of Anne Arundel, personally appeared
(corporate officer), known by me to be the
, (officer’s title) of the aforesaid corporation, and
in his/her capacity as an officer of the corporation certified that an Application for Substitution of Officer has been filed with
the City of Annapolis Alcoholic Beverage Control Board due to the fact that
(officer
being removed), previously an officer of the Corporation, can no longer serve as a licensee on the alcoholic beverage
license because the licensee:
is deceased has been removed from office
is retired no longer holds an office in the corporation or club.
The affiant further certified that the new officer and
(officer’s title) of the corporation has been issued stock in the corporation, that the shares of stock previously issued to
(officer being removed) have been returned to the corporation, and, with
that exception, the ownership of the corporation has not changed.
Name of Corporation/LLC
By
I HEREBY CERTIFY, on this day of , , before me, the subscriber, a
Notary Public of the State and County aforesaid, personally appeared
and made oath in due form of law that the matters and facts set forth above are true and correct.
WITNESS my hand and Notary Seal.
Notary Public My Commission expires
Signatures:
Officer being removed
Current licensee
Current licensee
City of Annapolis
Office of the City Clerk
160 Duke of Gloucester Street
Annapolis, MD 21401-2517
DepClerk@annapolis.gov • 410-263-7942 • Fax 410-280-1853 • TDD use MD Relay or 711 • www.annapolis.gov
Financial Information Form
Applicant must have a pecuniary interest in the establishment.
A false statement may constitute grounds for denial or revocation of the license.
Applicant name
Address
How long? Date of birth
Most recent employer
Address
Position or title
How long employed? Type of business
List any and all business interests.
I am or will be the owner partner stockholder member in the licensed business.
If a stockholder, how many shares?
My personal contribution will be $
Of this amount, $ will be in cash and will be or has been derived from the following sources:
If LLC member, contribution is cash property services.
Notice: Falsification of the information on this form may constitute grounds for denial or revocation of the license.
I HEREBY CERTIFY on this day of , , under the penalties of perjury,
that the matters and facts set forth above are true and correct to the best of my information and belief.
Applicant Witness
City of Annapolis
Office of the City Clerk
160 Duke of Gloucester Street
Annapolis, MD 21401-2517
DepClerk@annapolis.gov • 410-263-7942 • Fax 410-280-1853 • TDD use MD Relay or 711 • www.annapolis.gov
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Substitution or Deletion of Licensee Alcoholic Beverage Control (City of Annapolis)

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Completed 12 January 2021

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