Maryland > Statewide > Comptroller > Regulatory And Enforcement Division > Alcohol And Tobacco Tax Bureau
Application For Farmers Market Wine Permit - Maryland
| Application For Farmers Market Wine Permit Form. This is a Maryland form and can be used in Alcohol And Tobacco Tax Bureau Regulatory And Enforcement Division Comptroller Statewide . |
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For Official Use Only STATE OF CONNECTICUT DEPARTMENT OF CONSUMER PROTECTION Liquor Control Division Telephone: (860) 713-6210 Email: liquor.control@ct.gov Web Site: www.ct.gov/dcp APPLICATION FOR FARMERS' MARKET WINE PERMIT Please print clearly or type the information entered on this application. An application filing fee of $100.00 and permit fee of $250.00 is required. Please submit the required fee of $350.00. Check and/or money order should be made payable to "Treasurer, State of Connecticut" and must accompany this application. The application filing fee of $100 is non-refundable. Return your completed application, documentation and appropriate fee to: Department of Consumer Protection, License Services Division, 165 Capitol Avenue, Hartford, CT 06106 CURRENT FARM WINERY BUSINESS INFORMATION 1. Permit Number for Farm Winery: 3. Trade Name (DBA Name) 4. Business Address City State Zip Code 2. Permittee Name 5. Business Telephone Number 6. Business Fax Number 7. Business Email Address AUTHORIZED REPRESENTATIVE OF BACKER 8. Permittee Certification (To be signed by permittee applicant) Signed by Permittee Applicant Date I certify that the information provided in this application is true to the best of my knowledge. X__________________________________________________ 9. Backer Certification (To be signed by backer or the authorized representative of the backer) Signed by Backer or Authorized Representative of Backer Date I certify that the information provided in X__________________________________________________ this application is true to the best of my knowledge and that the permittee Print name of Backer or Representative Title of Backer or applicant identified in this application is Representative designated as my principal representative on the premises for which this application is being submitted. American LegalNet, Inc. www.FormsWorkFlow.com
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