Office Use Only: Order Filled by Date Filled Comptroller of Maryland MATT Regulatory Division Alcohol and Tobacco Tax P. O. Box 2999 Annapolis, Maryland 21404-2999 410- 260-7131/888-784-0145 Fax (410) 974-3201 Office Use Only Beginning Book No. Ending Book No. Keg Registration Booklet Order Form (please print or type) Licensee's Name T/A: License address Mailing address if different City State Zip Code Political Subdivision (County or Baltimore City) Date Telephone No. Md. Central Registration No. No. of books requested: (25 labels per book) Two copies to be sent to ATT Office Estimated number of kegs One copy to be kept by retailer Signature of Licensee COM/ATT-751 Rev. 7/07 American LegalNet, Inc. www.FormsWorkFlow.com