(A) ()Brand Name Enter full brand name. Do not abbreviate. ()Maryland Non-Resident or Resident Dealer Permit N ()List all sizes of this brand:()License mber of Maryland holesale istributor. ()Name of istributor. ()Assigned franchise territories. (Codes provided on reverse.) I hereby certify that we are the brand owner, U.S. Importer, or designated Maryland agent of said brand owner or U.S. Importer in accordance withMaryland laws. I further certify that these filings are not inconsistent with the Maryland Beer Franchise Fair Dealing Act or any prior franchise filingsmade with the Rev / Comptroller of Maryland P.O. Box Annapolis, Maryland 2140Phone: 410-260-7 Fax: 410-974- This supplementary statement will be made part of your license or permit file or will become a part of that license or permit file when issued.Any changes to the below must be in accordance with Maryland Beer Franchise Fair Dealing Act and must be promptly reported to the Comptroller in writing.Instructions on page 2 - read carefully - incomplete or incorrect forms will be returned.eltiTerutangiS dezirohtuADate Beer Franchise Form Page of American LegalNet, Inc. www.FormsWorkFlow.com Instructions for Completing COM/R330 1.This form must be completed using typewriter or hand -printed using ink and submitted in duplicate.2.A different page must be used for each brand. 3. Forms cannot be approved prior to being physically received in the Annapolis office of the . Questions pertaining to the proper completion of the form can be directed to (410) 260-. 4. Forms should only be used for the addition of new brands or to add a new wholesaler or additional territories for an existing brand. Requests for changes or deletions to existing brands must be made in letter form and must be in accordance with the provisions of the Maryland Beer Franchise Fair Dealing Act.5.Forms must be dated and signed by an of037cer of your company.6.Neatness, completeness and accuracy is essential. Incomplete or incorrect forms will be returned as disapproved and must be resubmitted.7. Detailed Instructions:þ . Maryland Non-Resident or Resident Dealer Permit Number - This is the official seven (7) digit number which appears on your license or permit (Example: . Sizes - List all sizes of this product that you wish to sell in Maryland.. License Number of Maryland Wholesale Distributor - This is the official seven (7) digit license number of the Maryland wholesale distributor who is being appointed l your brand. Contact your wholesaler to obtain this number. It is important that this number be accurate and legible. . Name of Distributor - List the full name of your Maryland wholesale distributor as it appears on the distributor222s license.. Assigned Franchise Territories - A three (3) digit code must appear for each county or subdivision (or part thereof) which you are assigning to a given wholesaler for a particular brand. Below is a list of the two-digit subdivision territory codes in Maryland. If you are assigning the whole territory, the code should be preceded by a 2230224 (Example: all þ of Allegany County would be 223001224). If you are assigning only a portion of a territory, then a 223P224 should precede the code (Example: Part of Allegany County would be 223P01224). þ Note: For every territory in which a 223P224 is designated, a detailed description and/or map must accompany the franchise form before approval can be granted. If you are assigning þ the entire State, except for Montgomery County, code 223099224 should be used. If you are selling to a ship chandler, code 223777224 should be used. If you are a wholesaler self-importing a product, you should use your license number in both the supplier and distributor boxes and code 223555224 should be used in the 037rst territory box. If you are a wholesaler acting þ as a secondary source (i.e. if you have a state-wide license and sell to other wholesalers in the state, exclusive of a sub-distributorship, then use code 223333224. Note that franchise þ forms must be 037led for all brands even those which you as a wholesaler may self-import or sell to others as a secondary source. In addition, when you as a wholesaler are selling to þ another wholesaler in a sub-distributorship capacity, these forms must also be completed and submitted. All items sold to Montgomery County (License Number: CD00001) þ must also be assigned using this form. Note: þ Always use the 037rst territory code block and leave those not needed blank. If you need more than 037ve (5) territory boxes for a given wholesaler, skip to the next line repeating the wholesaler222s number and name. If you need more space for additional distributors, use a second form, repeating your license or permit number and brand information at the top. Consecutively number each page you are submitting at one time at the top in the space provided. 01 Allegany Countyþ 07 Carroll County 13 Harford County 19 St. Mary222s County 02 Anne Arundel Countyþ 08 Cecil County 14 Howard County 20 Somerset County 03 Baltimore Countyþ 09 Charles County 15 Kent County 21 Talbot County 04 Baltimore Cityþ 10 Dorchester County 16 Montgomery County 22 WashingtonCounty 05 Calvert Countyþ 11 Frederick County 17 Prince George222s County 23 Wicomico County 06 Caroline Countyþ 12 Garrett County 18 Queen Anne222s County 24 Worcester County 0 - Precedes whole territory (Ex. 001) 333 - Secondary Source (wholesalers only) P - Precedes partial territory (Ex. P01) 555 - Self-Import Brand (wholesalers only) 099 - Entire state of Maryland Except Montgomery County 777 - Ship Chandler Rev / American LegalNet, Inc. www.FormsWorkFlow.com