Application For An Off Site Permit {384}

For APPLICATION FOR A Date ____________________________ , 2 _______________ To the Comptroller of Maryland Application is made by the undersigned under the provisions of Article 2B of the Annotated Code of Maryland, as amended, title "Alcoholic Beverages" for the permit indicated above. The term of Off-Site Permit is 1 year, permit expires December 31st annually Number _______________ Permit Year _____________ 1. License name and/or trade name: __________________________________________________ _____________________________________________________________________________ 2. Mailing address: ________________________________________________________________ Business Phone No.: _________________________________ License Number: Stub Number ___________ Approved ______________ Date __________________ Check Number __________ Check Amount $________ M __ - __ __ __ __ __ Deposit Date____________ Central Registration Number ___ ___ ___ ___ ___ ___ ___ ___ 3. Do the applicants agree to conform to all laws, rules, and regulations of the State of Maryland relating to the business in which they propose to engage under this permit? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. Do the applicants agree to keep Owner of Premise form at license location for 3 years or until audited?. . . . . . . 5. Do the holders of a Class 5 Brewery license, Class 7 Micro-Brewery license or a Class 8 Farm Brewery license agree to sell to the consumer not more than 288 ounces of beer that has been produced by the permit holder for off premises consumption? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. . Must be signed by a licensee. ..... Yes Yes No No Yes No No to the best of my knowledge, information and belief. Signature of Licensee Type or Print Name knowledge, and that I am authorized and empowered to issue a check and make payment for the license/permit fee on behalf of the applicant and am also authorized to receive a refund check. Name of Corporation; Partners of Partnership; or Individual (include Trade Name) Complete Mailing Address COM 3 American LegalNet, Inc. www.FormsWorkFlow.com