Application For A Brewery Special Event Permit {385}

385 Form APPLICATION FOR A BREWERY SPECIAL EVENT PERMIT 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. This application shall be filed with the Office of the Comptroller not less than 15 days prior to any event. 1. License name and/or trade name: ______________________________________________ 2. Mailing address: ____________________________________________________________ _________________________________________________________________________ Business Phone No.: ________________________________________________________ License Number Office Use Only Number _______________ Permit Year _____________ Stub Number ___________ Approved ______________ Date __________________ Check Number __________ Check Amount $ ________ M ___ - ___ ___ ___ ___ ___ Federal Identification Number ___ ___ - ___ ___ ___ ___ ___ ___ ___ Deposit Date____________ Yes No 3. Is the event being held on the premises of the brewery? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. Description of Event ______________________________________________________________________________________ ______________________________________________________________________________________________________ 5. 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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No 6. The permit for which this application is made is to be for the following day(s) ________________________________________ The applicant tenders herewith the sum of $25.00 in payment. A new application and payment must be submitted for each special event. 7. Must be signed by a brewery licensee. Affidavit I/we do solemnly declare and affirm under penalties of perjury that the contents of the foregoing document are true and correct to the best of my knowledge, information and belief. Signature of Brewery Licensee Type or Print Name 8. This section must be completed by the owner of the premises where the event will take place. Statement of owner of premises required in connection with alcoholic beverages law of Maryland: I/we hereby certify that I am/ we are the owner(s) of the property known as ________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ named as the foregoing application made to the Comptroller of Maryland under the Alcoholic Beverages Law of Maryland; that I/we assent to the granting of the permit applied for, and that I/we hereby authorize the Comptroller of Maryland, his duly authorized deputies, inspectors and clerks, the Board of License Commissioners of the jurisdiction in which the place of business is located, its duly authorized agents and employees, and any peace officer of such jurisdiction to inspect and search, without warrant, the premises upon which the business is to be conducted, and any and all parts of the building in which said business is to be conducted, at any and all hours. COM/RAD-385 13-49 06/13 American LegalNet, Inc. www.FormsWorkFlow.com 385 Affidavit Form APPLICATION FOR A BREWERY SPECIAL EVENT PERMIT I do solemnly declare and affirm under the penalties of perjury that the contents of the foregoing document are true and correct to the best of my knowledge, information and belief. Signature Type or print name Title Date Third Party Checks Affidavit I do solemnly declare and affirm under the penalties of perjury that the contents below are true and correct to the best of my 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. Name of Corporation; Partners of Partnership; or Individual (include Trade Name) Complete Mailing Address Signature of Owner, Partner or Corporate Officer Title Federal Identification Number and/or Social Security Number Date Contact Information Comptroller of Maryland Revenue Administration Center Licensing and Registration P.O. Box 2999 Annapolis, Maryland 21404-2999 410-260-7980 or 800-MD-TAXES www.marylandtaxes.com COM/RAD-012 COM/RAD-385 Revised 13-49 06/12 06/13 American LegalNet, Inc. www.FormsWorkFlow.com