Name(s) of license applicant(s)License NumberTrade namePresent Address; Number and StreetCityCountyZip Code Street AddressCityCountyZip CodeDescribe premisesTelephone numberFax numberDate of anticipated moveTitleDate (I, We) hereby certify, that (I am, we are) the owner(s) of property known as þ named in the afore going 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 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. Comptroller of Maryland DivisionLicensinPO Box 2999Annapolis, MD 21404410-260-7Application must be approved prior to move367-1the best of my knowledge, information and belief. Owner222s signature þ Date Type or print name of owner American LegalNet, Inc. www.FormsWorkFlow.com