Comptroller of Maryland MATT Regulatory Division Alcohol and Tobacco Tax Louis L. Goldstein Treasury Building P.O. Box 2999 Annapolis, Maryland 21404-2999 410-260-7327 OFFICE USE ONLY License # Stub# Date Issued OFFICE USE ONLY Check Number Check Amount $ Deposit Date 888-784-0145 Fax # 410-974-3201 Approved Date Application for a Class Beer, Wine and Liquor License E, F or G WATER VESSEL CLASS E - $150.00 license fee RAILROAD CLASS F $200.00 license fee AIRPLANE CLASS G $200.00 license fee NOTE: Renewal applications must be received no later than March 31. Check one: G New Application G Renewal of License No. Check one: G Partnership G Corporation G Limited Liability Co. G Individual NOTE: Beer, Wine and Liquor License is only available to boats transporting for hire passengers from ports in Maryland to other ports in Maryland or to coastal ports in other states or foreign ports; or boats licensed to operate tours within Maryland waterways; to operators of cars on railroads; and to operators of airplanes. TO THE COMPTROLLER OF MARYLAND: Application is made by the undersigned under the provisions of Article 2B, as amended, title “Alcoholic Beverages”, for the class license indicated above, and the applicant(s) submit(s) and certify(ies) to the following information required by the article. Application may be made by any three officers, or three employees residing in this state, duly authorized by the corporation to apply for the license. 1. APPLICANTS (1) (2) (3) Name Residence Home Phone Date of Birth Place of Birth Social Security No. * Title or Position held in Organization * 2. MD Resident Since MD Resident Since MD Resident Since The disclosure of applicant’s Social Security Number is mandatory and will be used for background investigations pursuant to Section 10-201 of Article 2B of the Annotated Code of Maryland. a. Name and trade name (if applicable) of company on whose behalf license is desired: b. Mailing address: (street address or post office box) (city/state) c. (nine digit zip code) Physical location if mailing address is a post office box (street address) COM/ATT-009 Rev. 7/07 -overAmerican LegalNet, Inc. www.FormsWorkflow.com 3. Usual physical location where boat is housed (dock, wharf, pier, etc.): (if applicable) 4. Boat Name (if applicable) 5. Business Phone Number(s) Fax Number E-mail address 6. a. Date business began b. Type of accounting period (Calendar Year, Fiscal Year, etc.) Month FY begins c. If Corporation or Limited Liability Company - date chartered State d. Federal Employer Identification No. 7. The name and address of the owner of the boat, plane, or train 8. The applicant is presently the holder of the following alcoholic beverage licenses or permits issued by Maryland, any other state or jurisdiction, or the United States government (if more space is needed, attach additional sheet). Issuing Authority 9. Type Expiration Date Number The applicant has previously held the following alcoholic beverage licenses or permit: 10. The applicant has applications pending for the following alcoholic beverage licenses or permits: 11. Please answer each of the following questions: (attach explanation if “Yes” to “*” questions) *A. Has any applicant ever been convicted of a felony by any State or Federal Court?....................................... G Yes G No *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?............................................................................ G Yes G No *C. Has any applicant ever been denied or had revoked an alcoholic beverage license or permit?..................... G Yes G No *D. Do any of the applicants or their immediate families have an interest in a Maryland wholesale or retail alcoholic beverage license, either issued or applied for?................................................................................ G Yes G No 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?................................................................. G Yes G No The applicants submit herewith a statement duly executed and acknowledged by the company on whose behalf the license is desired, assenting to the granting to the license applied for, authorizing the comptroller, his duly authorized deputies, inspectors and clerks, to inspect and search, without warrant, any and all airplanes, cars, or boats to which such license applies, at any and all hours, provided no such inspection or search shall be made at such time or in such manner as to delay or interfere with movement of any airplane, train, or boat. ................................................................................................................................................. G Yes G No E. F. — CONTINUED ON NEXT PAGE — American LegalNet, Inc. www.FormsWorkflow.com 12. 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 license by this office. The applicant hereby affirms (complete one): 9 (a) the applicant is not an employer required to provide coverage by the Maryland Workers’ Compensation Law; (b) the 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, the following is submitted: or, 9 1. Name of Insurance Company: 2. Policy or Binder Number: 13. The license for which this application is made is to be for the year beginning May 1, above is $ . Fee for license applied for . If new application, do not remit license fee with application; if renewal application, remit fee with your application. AFFIDAVIT 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 of applicant Date Signature of applicant Date Signature of applicant Date 14. Statement of company required in connection with Alcoholic Beverage Law of Maryland I HEREBY CERTIFY, That I am the owner of (name of water vessel, airplane, or railroad) named in the application made by to the Comptroller of Maryland under the Alcoholic Beverages Law of Maryland for the class license indicated, expiring April 30, ; and that I assent to the granting of the license applied for, and that I hereby authorize the Comptroller of Maryland, his duly authorized deputies, inspectors and clerks to inspect and search, without warrant any and all airplanes, cars, or boats to which such license applies, at any and all hours, provided no such inspection or search shall be made at such time or in such manner as to delay or interfere with the movement of any airplane, train, or boat. AFFIDAVIT 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 COM/ATT-009 Revised 7/07 American LegalNet, Inc. www.FormsWorkflow.com