MARYLAND FORM 369 APPLICATION FOR CLASS E, F OR G LICENSE Office Use Only Check Number __________ Amount $ _____________ Deposit Date____________ Approved ______________ Date __________________ License Number _________ Stub Number ___________ Date Issued ____________ NOTE: Renewal applications must be received no later than March 31. Application for a Beer, Wine and Liquor License: Class: E WATER VESSEL CLASS - $150.00 license fee F RAILROAD CLASS G AIRPLANE CLASS Check one: Check one: New License Partnership $200.00 license fee $200.00 license fee Renewal of License Number ______________________ Corporation Limited Liability Co. 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 of 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 the Alcoholic Beverages Article of the Annotated Code of Maryland, 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 Name 1 2 3 Residence Home Phone Date of Birth Place of Birth Social Security (*) Title or Position held in Organization 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 the Alcoholic Beverages Article of the Annotated Code of Maryland. 2. 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, nine digit zip code) _____________________________________________________________________________________________________ c. Physical location if mailing address is a post office box ________________________________________________________ (street address) 3. 4. 5. 6. Usual physical location where boat is housed (dock, wharf, pier, etc.), if applicable: ___________________________________ _____________________________________________________________________________________________________ Boat Name (if applicable) _________________________________________________________________________________ Business Phone Number(s) _______________________________ Fax Number ________________ E-mail address ____________________ 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 ___________________________________________________ _____________________________________________________________________________________________________ COM-FED/RLS-369 10/17 American LegalNet, Inc. www.FormsWorkFlow.com MARYLAND FORM 369 APPLICATION FOR CLASS E, F OR G LICENSE 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 Type Expiration Date Number 9. 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. *B. *C. *D. E. F. Has any applicant ever been convicted of a felony by any State or Federal Court? . . . . . . . . . . . . . . . . . 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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . Has any applicant ever been denied or had revoked an alcoholic beverage license or permit? . . . . . . . . . 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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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? . . . . . . . . . . . . . . . . . . . . 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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . YES YES YES YES YES NO NO NO NO NO YES NO 12. Section 9-104 of the Alcoholic Beverages 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): (a) the applicant is not an employer required to provide coverage by the Maryland Workers' Compensation Law; or, (b) the applicant is an employer required to provide employee coverage by the Maryland Workers' Compen