Comptroller of Maryland MATT Regulatory Division Alcohol and Tobacco Tax P. O. Box 2999 Louis L. Goldstein Treasury Building Annapolis, Maryland 21404-2999 Application for Change in License Location (Note: Application must be approved prior to move) 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 present location is __________________________________________________________________________________ (number and street - town - county - zip code - other description) The NEW location for which license transfer is desired is known as: _________________________________________________ ________________________________________________________________________________________________________ Fully describe premises ____________________________________________________________________________________ ________________________________________________________________________________________________________ Telephone number Fax number ________________________________________ Date of anticipated move Affidavit I do solemnly declare and affirm under the penalties of perjury that the contents of the foregoing documents are true and correct to the best of my knowledge, information and belief. Signature of owner, partner or corporate officer Type or print name of owner, partner or corporate officer Title Date 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 aforegoing application made to the Comptroller of Maryland 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 Comptroller of Maryland, 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 office 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 the building(s) in which said business is to be conducted, at any and all hours. _________________________________________________________ Owner’s signature Type or print name of owner COM/ATT7-1 Rev. 07/07 Date American LegalNet, Inc. www.FormsWorkflow.com