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 Approved Date License # Stub # Date Issued OFFICE USE ONLY Check Number Check Amount $ Deposit__________________ Date 888-784-0145 Fax# 410-974-3201 Application for Renewal of Alcoholic Beverages License Issued by the Comptroller of Maryland Note: This application must be filed on or before March 31 with the Comptroller of Maryland, Annapolis, Maryland; otherwise a new application and an application fee will be required. Licenses will be issued beginning April 15. Licenses must be displayed on or before May 1. For the use of: (Check one) 9 An individual 9 Partnership 9 Corporation 9 Limited Liability Company Number and class of license now held: (Copy from current license) Class(es) of license(s) desired: (Insert in accordance with instruction sheet attached) To the Comptroller of Maryland: Application is made by the undersigned under the provision of Article 2B of the Annotated Code of Maryland, as amended, for a renewal of (my, our) license, and the applicant(s) submit(s) and certify(ies) to the following information: 1. All the facts and information contained in the original application as submitted are true and unchanged to this time. 2. (I)(We), or anyone connected with the business conducted under the license for which a renewal is herein applied for, have not furnished and will not furnish to any retail licensee: (1) any sign, display, or other form of advertisement of any value in excess of the limitation provided under Article 2B, or (2) any money or other thing of value, (3) make any gift, or (4) offer any gratuity, or (5) any personal service (other than stipulated in official bulletins issued and published by the Comptroller). *3. (I)(We) produced not more than 27,500 gallons of (my)(our) own wine during the most recent license year ending April 30: *Class 6 Limited Winery wholesale licensee only. 4. List any offense, or offenses, against the laws of the state or of the United States, have you been convicted of during the present license year ending April 30: 5. Applicant’s corporation name is: Applicant’s trade name is: Location of license premises is: Describe premises: Telephone Number: Fax Number: E-mail address: Other Location(s): 6. Applicant(s): Give name(s) and residence(s) - if corporation, list all officers on separate sheet a. Name Title Residence Name Title Residence Name Title Residence Name Title Residence b. c. d. American LegalNet, Inc. www.FormsWorkflow.com LICENSEE 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. *a. Signature of President or Vice President *Note: If signer is one of the applicants, he/she must also sign as an applicant. b. Signature of Applicant c. Signature of Applicant d. (Corporation Seal) Signature of Applicant 7. 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 foregoing 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 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 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. OWNER OF PREMISES AFFIDAVIT I do solemnly declare and affirm under the penalties of perjury that the content of the foregoing document are true and correct to the best of my knowledge, information and belief. Signature Type or Print Name Title Date The license for which this application is made is to be for the year beginning May 1, 20 . Fee for license applied for In addition to $30.00 renewal fee. Please remit fee with your renewal application. above is $ Licenses and Fees Manufacturer’s License Class 1 Class 2 Class 3 Class 4 Class 5 Class 6 Class 7 Distillery Rectifying Winery Limited Winery Brewery Pub-Brewery Micro-Brewery Annual Fee Annual Fee Annual Fee Annual Fee Annual Fee Annual Fee Annual Fee Wholesaler’s License $2,000.00 $600.00 $750.00 $200.00 $1,500.00 $500.00 $500.00 Class 1 Class 2 Class 3 Class 4 Class 5 Class 6 Beer, Wine and Liquor Wine and Liquor Beer and Wine Beer Wine Limited Wine Annual Fee Annual Fee Annual Fee Annual Fee Annual Fee Annual Fee $2,000.00 $1,750.00 $1,500.00 $1,250.00 $1,250.00 $50.00 Renewal for all licenses is $30.00 COM/ATT-008 Rev. 7/07 American LegalNet, Inc. www.FormsWorkflow.com