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Talbot County - Application for Alcoholic Beverages License

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BROWSE TALBOT COUNTY GOVERNMENT (MD) FORMS

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Page 1 of 5
APPLICATION FOR ALCOHOLIC BEVERAGES LICENSE
TALBOT COUNTY
(PLEASE PRINT OR TYPE)
Application is made by the undersigned under Chapter 11, The Talbot County Code “Alcoholic
Beverages," Revised February 12, 2018 for a Class A ___ , Class B___ , Class B-F ___, Class B-R___ ,
Class B-T ___, Class C ___, Class D ___, Class E ___, Class F-A ___, Class G ___, Class GC ___,
Class I ___License or Caterer’s Endorsement___, (see attached license class list) and the applicant(s)
submit(s) and certify(ies) to the following information as required:
Type of Entity: (CIRCLE ONE) Corporation, LLC, Partnership, Sole Proprietor, Club or Association
(Incorporated or Unincorporated):
___________________________________________________________________________________
Corporate Entity Name
___________________________________________________________________________________
Name of Establishment (d/b/a)
___________________________________________________________________________________
Physical Address where license is to be used:
___________________________________________________________________________________
Mailing Address of Establishment:
Names of Applicants (Type or Print):
1._________________________________________________________________________________
NAME TITLE
2._________________________________________________________________________________
NAME TITLE
PRESIDENT, VICE-PRESIDENT, MANAGING
MEMBER
* If President, Vice President, Managing Member is an * ___________________________________
Applicant, he/she must also sign as applicant. President or Vice President Signature
1. ______________________________________
Applicant Signature
2. ______________________________________
Applicant Signature
Page 2 of 5
A
PPLICATION
F
OR
T
ALBOT
C
A
LCOHOLIC
B
EVERAGE
Name & Telephone # of President or Vice-President:
___________________________________________________________________________________
Names and Addresses of all other officers:
1. Address / County / Telephone # / Years of Residency at this address of Applicant(s):
a. _____________________________________________________________________________
Address of Applicant
_____________________/ _____________________________________ / ________________
County of Applicant Telephone Yrs. of Residency
b. ____________________________________________________________________________
Address of Applicant
_____________________/ _____________________________________ / ________________
County of Applicant Telephone Yrs. of Residency
2. Are you a citizen of the United States?
a. _______Yes _______No
b. _______Yes _______No
3. If naturalized, when and where?
a. ______________________________________________________________________________
b. ______________________________________________________________________________
4. Place of birth.
a. ____________________________________________________ / _______________________
City/County State
b. ____________________________________________________ / _______________________
City/County State
Page 3 of 5
A
PPLICATION
F
OR
T
ALBOT
C
A
LCOHOLIC
B
EVERAGE
5. Are you over 21 years of age?
a. _______Yes _______No
b. _______Yes _______No
6. Owner(s) of the premises where the alcoholic beverages will be sold:
_________________________________________________________________________________
Full Name of Owner(s) of the Premises
_________________________________________________________________________________
Mailing Address of Owner(s)
_________________________________________________________________________________
Telephone Number(s) of Owner(s)
7. Have you ever been convicted of a felony, misdemeanor involving moral turpitude, been adjudged
guilty of violating the laws governing the sale of alcohol beverages, controlled dangerous
substances, gambling in Maryland or any other state in the United States or foreign country?
a. _______Yes _______No
b. _______Yes _______No
If you answered yes, give details:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
8. Have you ever had a license for the sale of an alcoholic beverage (a) Suspended or (b) Revoked?
a. _______Yes _______No
b. _______Yes _______No
If you answered yes, give details:
________________________________________________________________________________
9. Does any other person have a financial interest in the license applied for, or in the business to be
conducted hereunder?
a. _______Yes _______No
b. _______Yes _______No
Page 4 of 5
A
PPLICATION
F
OR
T
ALBOT
C
A
LCOHOLIC
B
EVERAGE
If you answered yes, give details:
________________________________________________________________________________
10. Do you hold a financial interest in any other alcoholic beverage business or license in Talbot
County?
a. _______Yes _______No
b. _______Yes _______No
If you answered yes, give details:
________________________________________________________________________________
11. Do you or the entity applying for the license hold or ever held a license for the sale of alcoholic
beverages and, if so, in what state and at what location?
a. _____________________________________________________________________________
b.______________________________________________________________________________
12. Does any manufacturer, brewer, distiller or wholesaler, directly or indirectly have any financial
interest in the premises or business of the applicants?
a. _______Yes _______No
b. _______Yes _______No
If you answered yes, give details:
________________________________________________________________________________
13. Will you convey or grant any such interest to any manufacturer, brewer, distiller or wholesaler at
the time of making this application?
a. _______Yes _______No
b. _______Yes _______No
14. If granted a license will you incur any indebtedness or other financial obligation, directly or
indirectly, to any manufacturer, brewer, distiller or wholesaler other than for the purchase of
alcoholic beverages?
a. _______Yes _______No
b. _______Yes _______No
Page 5 of 5
A
PPLICATION
F
OR
T
ALBOT
C
A
LCOHOLIC
B
EVERAGE
15. If granted a license will you conform to all laws and regulations relating to the business in which
you propose to engage?
a. _______Yes _______No
b. _______Yes _______No
_______________________________________________
Signature of Applicant
_______________________________________________
Signature of Applicant
STATE OF MARYLAND, TALBOT COUNTY to wit:
I HEREBY CERTIFY, that on this _______ day of ________________, 20_____, before me,
the subscriber, a Notary Public of the State and County aforesaid, personally appeared
_________________________, known to me (or satisfactorily proven) to be the person whose name is
subscribed to the within instrument, and acknowledged that ___ executed the foregoing instrument for
the purposes therein contained and further acknowledged it to be his/her act.
AS WITNESS my hand and Notarial seal.
_________________________________________
(Seal) Notary Public
My commission expires: ____________________
STATE OF MARYLAND, TALBOT COUNTY to wit:
I HEREBY CERTIFY, that on this _______ day of ________________, 20_____, before me,
the subscriber, a Notary Public of the State and County aforesaid, personally appeared
_________________________, known to me (or satisfactorily proven) to be the person whose name is
subscribed to the within instrument, and acknowledged that ___ executed the foregoing instrument for
the purposes therein contained and further acknowledged it to be his/her act.
AS WITNESS my hand and Notarial seal.
_________________________________________
(Seal) Notary Public
My commission expires: ____________________
I:\County Attorney\Liquor Board\^Forms\APPLICATION FOR NEW LICENSE\APPLICATION FORM - Updated for Class I.doc
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Talbot County - Application for Alcoholic Beverages License

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Completed 30 May 2020

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