Comptroller of Maryland MATT Regulatory Division Alcohol and Tobacco Tax Louis L. Goldstein Treasury Building P. O. Box 2999 Annapolis, Maryland 21404-2999 Application for an Additional License Location This statement is to be attached to and made a part of the application of: Name(s) of license applicant(s) license number Whose trade name is Whose MAIN location is A BRANCH LOCATION which the license is desired to cover is known as: (number and street - town - county - other description) Fully describe premises ____________________________________________________ Signature of Officer/License Applicant STATE OF MARYLAND ss: THIS CERTIFIES, That on the day of , , before the subscriber, a of the State of Maryland, personally appeared the applicant(s) named in the afore going application, and made oath in due form of law that the statements there are true to the best of the applicant’s knowledge and belief. WITNESS my hand and official seal (Seal) 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 property known as named in the afore going application made to the State Comptroller under the Alcoholic Beverages Law of Maryland; that (I, we) assent to the granting of the license applied for, and that (I, we) hereby authorize the State Comptroller, his duly authorized deputies, inspectors and clerks, the Board of License Commissioners of the County in which the place of business is located, its duly authorized agents and employees, and any peace officer of such county to inspect and search, without warrant, the premises upon which the business is to be conducted, and any and all parts of building in which said business is to be conducted, at any and all hours. Witness (our/my) hand(s) and seal(s) this day of , Signature of Owner of Premise SS: STATE OF MARYLAND THIS CERTIFIES, That on the day of , . before the subscriber, a of the State of Maryland, personally appeared and acknowledged the execution of the foregoing statement to be act. WITNESS my hand and official seal. (Seal) COM/ATT-7-2 Rev. 7/07 American LegalNet, Inc. www.FormsWorkflow.com