Maryland > Statewide > Comptroller > Regulatory And Enforcement Division > Alcohol And Tobacco Tax Bureau
Permit Application ATT-010 - Maryland
| Permit Application 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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Office Use Only Number VID ________ YR _______ Stub # VID #'s Comptroller of Maryland MATT Regulatory Division Alcohol and Tobacco Tax Louis L. Goldstein Treasury Building P.O. Box 2999 Annapolis, MD 21404 410-260-7327 888-784-0145 http://compnet.comp.state.md.us/MATT_Regulatory_Division/ Office Use Only Check Number Check Amount $ Deposit Date Permit Application Approved Date Note: · Read instructions carefully. Office use only Incomplete or incorrect application will be returned. · File a separate application for each type of permit desired. · All applicants must complete Sections 1 and 7. · All renewal applications received after October 31 must be considered new applications. Check the type of permit you are applying for: (See back page for explanation) G ND-Non-resident Dealer G IE-Import-Export G NS-Non-resident Storage G NW-Non-resident Winery G PT-Public Transportation $100.00 $75.00 $500.00 $50.00 $75.00 G IT-Individual Transportation G IS-Individual Storage G PS-Public Storage G ST-Storage & Transportation G FP-Family Beer and Wine Facility $10.00 $50.00 $75.00 $100.00 $400.00 G CD-Change of Domicile G NC-Non-beverage "C" G NE-Non-beverage "E" G Vehicle Identification Card $ 5.00 $50.00 Gratis $ 10.00 each Section 1 - All Applicants Must Complete This Section G New Permit G Renewal (give permit no.) A. Permit is to be issued in the name Corporate name for corporation; all partners if partnership; individual name and trade name B. Whose telephone number is (___) or (___) Toll Free Number FAX (___) E-mail address C. Whose mailing address is Street and Number City County State Nine - digit ZIP Code D. Provide physical location address if the mailing address is a P.O. Box E. Applicant is a Corporation Limited Liability Co. Partnership Individual F. G G G G ¤ ¤ List Federal Identification Number List Social Security Number* * The disclosure of applicant's Social Security Number is mandatory and will be used for background investigations pursuant to Article 2B of the Annotated Code of Maryland. The applicant is presently the holder of the following Alcoholic Beverages Permits or Licenses issued by any other state, the state of Maryland, or the United States Government (if additional space is needed, attach separate paper). If NONE, so state. Issuing authority Type Expiration date Number COM/ATT-010 Rev. 9/07 (continued on next page) American LegalNet, Inc. www.FormsWorkflow.com G. Has the applicant ever been convicted of a felony by any state or federal court? ................................................. G Yes G No H. Does the applicant agree to conform to all the laws, rules and regulations of the state of Maryland relating to the business proposed under this permit?............................................................................. G Yes G No I. Does the applicant authorize the Comptroller of Maryland and the comptroller's duly authorized personnel to search without warrant any vehicle, railroad cars, vessel, aircraft or premises used in the business to be conducted under this permit at any and all hours agreeable to the laws of the state of Maryland?....................... G Yes G No J. Has the applicant ever been convicted of a violation of the laws of the United States, Maryland or any other state concerning alcoholic beverages, gaming, or gambling? (If yes, explain in detail on separate paper - list offense, court, date, etc.) ....................................................................................................................................... G Yes G No K. Does the applicant have an interest in a Maryland alcoholic beverage wholesale or retail license, either issued or applied for? Provide particulars on separate attachment.................................................................................. G Yes G No L. Section 9-104 of Article 2B of the Annotated Code of Maryland titled "Workers' Compensation Compliance" requires the evidence of such compliance prior to the issuance of any permit by this office. The applicant hereby affirms (complete one): G a. G b. Applicant is not an employer required to provide coverage by the Maryland Workers' Compensation Law; or Applicant is an employer required to provide employee coverage by the Maryland Workers' Compensation Law and has secured such coverage. As evidence of such coverage, list the name of insurance company and policy or binder number. Section 2 - Non-beverage Applicants Complete This Section in Addition to Sections 1, 4, & 7 A. Alcohol purchased under this permit is to be used for B. If the applicant is a hospital, educational or charitable organization qualified for non-beverage "E" gratis permit, set forth the nature of the organization and operation. Section 3 - Change of Domicile Permit Applicants Complete This Section in Addition to Sections 1 & 7 A. I am changing my domicile and moving my household effects from Street and Number City Country State Nine Digit Zip Code to Street and Number City Country State Nine Digit Zip Code B. Attach an inventory of the alcoholic beverages you wish to bring into this state showing container size, brand name, type and proof or alcoholic content. Maryland tax at the following rates should accompany this application: Wine 40 cents per gallon, Beer 9 cents per gallon, Distilled Spirits (alcoholic beverages other than wine or beer) $1.50 per gallon up to 100 proof plus .015 cents per 1 proof over 100 proof. Section 4 - Public Storage, Individual Storage & Family Beer and Wine Facility Applicants Complete This Section in Addition to Sections 1 & 7.Non-beverage Applicants Complete This Section in Addition to Sections 1, 2, & 7. Public Storage and Transportation Applicants Complete This Section in Addition to Sections 1, 5, & 7. A. If premises is in Maryland give exact site location (do not give P.O. address). Street and Number City Country State Rear, Front, 2nd Floor, etc. Other site locations B. Physical description of premises applied for (give distance to nearest prominent landmark and specify which portion of the building is to be covered by the permit if all of structure is not covered) (Section 4 continues at the top of the next page) American LegalNet, Inc. www.FormsWorkflow.com C. The premises is owned by D. Whose mailing address is E. (I) (We) certify that (I am) (We are) the owner(s) of the above described premises, and (I) (We) hereby consent to the use of the premises in the conduct of the business to be engaged in under t
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