Application For A Statewide Caterers License {371}

MARYLAND FORM 371 APPLICATION FOR A STATEWIDE CATERER'S LICENSE See page 5 for guidelines and instructions. For the use of: (Check one) An individual Corporation Partnership Limited Liability Co. Check type of license desired: General Limited OFFICE USE ONLY Check Number __________ Amount $ _____________ Deposit Date____________ Approved ______________ . . . . Annual Fee . $2,000.00 . $1,500.00 . $1,000.00 . . .$750.00 Date _________________ License # ______________ Stub # ________________ Date Issued ____________ License General SCAT License . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Limited SCAT License - More than 600,000 but less than 1,000,000 total population . Limited SCAT License - More than 300,000 but less than 600,000 total population . . Limited SCAT License - Not more than 300,000 total population . . . . . . . . . . . . . . . Do not remit any license fee with this application. If your application is approved, you will be advised of the appropriate license fee based upon provisions of the law. Date If applying for a Limited License, list the three contiguous political subdivisions of the state in which you plan to operate: Application is made by the undersigned under the provisions of Article 2B, as amended, title "Alcoholic Beverages", for the type of license checked above, and the applicant(s) submit and certify to the following information required by law: 1. Applicants * Name Residence Home Phone Date of Birth Place of Birth Social Security Number ** Position Qualifying Maryland Resident? *** MD Resident Since (Date) * ** In the case of a corporation, the law requires three officers to apply as license applicants, unless less than three exist. (In the latter case, submit supporting documentation.) The disclosure of applicant's Social Security Number is mandatory and will be used for background investigations, including a criminal history records checks, pursuant to Section 10-201 of Article 2B, Annotated Code of Maryland. Yes No Yes No Yes No (1) (2) (3) *** At least one applicant must be a voter and taxpayer in Maryland presently and for the two immediately preceding years. In case of partnership, all individuals must meet this requirement. 2. Company name and/or trade name ________________________________________________________________________ 3. Location of desired licensed premises/principal office __________________________________________________________ 4. Description of premises to be covered under license applied for (lot, type, size, and construction of building) _____________ _____________________________________________________________________________________________________ 5. Business phone number(s) ___________________________________________Fax number __________________________ E-mail address _________________________________________________________________________________________ COM/RAD-371 Rev. 02/14 American LegalNet, Inc. www.FormsWorkFlow.com MARYLAND FORM 371 APPLICATION FOR A STATEWIDE CATERER'S LICENSE Page 2 6. a. Date business began _________________________________________________________________________________ b. Type of accounting period (calendar yr, fiscal yr, etc.) ____________________________ Month FY begins _____________ c. If corporation or limited liability company, date chartered _________________________ State ______________________ d. Federal Employer Identification Number ___________________________________________________________________ e. MD Central Registration Number ________________________________________________________________________ 7. Name and address of the owner of premises __________________________________________________________________ 8. The applicants are presently the holders of the following alcoholic beverages licenses or permits issued by the state of Maryland, any other state or jurisdiction, or the United States government (if more space is needed, attach additional sheet). Issuing Authority Type Expiration Date Number 9. The applicants have previously held the following alcoholic beverage licenses or permits: ______________________________ _____________________________________________________________________________________________________ 10. The applicants have applications pending for the following alcoholic beverage licenses or permits: ______________________ _____________________________________________________________________________________________________ 11. Please answer each of the following questions applicable to all individual applicants: (attach explanation if "Yes" to (*) questions): *A. Has any applicant ever been convicted of a felony by any state or federal court? . . . . . . . . . . . . . . . . . . . . *B. Has any 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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . *C. Has any applicant ever been denied or had revoked an alcoholic beverage license or permit? . . . . . . . . . . . . D. Do the applicants agree to conform to all the laws, rules and regulations of the state of Maryland relating to the business in which they propose to engage under this license? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E. Do the applicants authorize the comptroller and his duly authorized personnel to search without warrant any premise or vehicle used in the business to be conducted under this license at any and all hours agreeable to the state of Maryland? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F. Do the applicants meet all state and local requirements and hold all requisite licenses relating to the catering business conducted? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G. Do the applicants hold the requisite health department permit or certification to engage in catering activities in the jurisdiction where their principal office is located? (If yes, attach a copy of license or certification. If no, attach documentation from the appropriate authority indicating no permit or certification is required.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . H. Do the applicants hold a retail alcoholic beverage license solely for the privi