Common Carrier Permit Application for Direct Wine Shipment Section 1 - Applicant Information New Permit A. Name of Contact Renewal (Permit #) CC- __________ Number ___________________ Permit Year ________________ Stub Number ______________ Corporate Name and T/A of Common Carrier Phone Number Fax Number Approved _________________ Date ______________________ B. E-mail address Check Number _____________ Mailing address Check Amount $ ___________ Deposit Date _______________ C. City State Zip If the mailing address is a P.O. Box provide physical location address D. E. Applicant is a: Corporation Partnership Individual Section 2 - Permit Information Social Security Number - - - A. Is the applicant a business entity that holds itself out as being available to the public to transport in interstate or foreign commerce for compensation any class of passenger or property? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Yes No Yes No Yes No B. Does the applicant agree to submit to the Comptroller at the time of application, and on request, information ............. C. Does the applicant agree to conform to all the laws, rules, and regulations of the State of Maryland relating to the business proposed under this permit? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D. Does the applicant agree to verify annually in a manner acceptable to the Comptroller that direct wine shipments to Maryland consumers were made under valid direct wine shipper's permits? . . . . . . . . . . . . . . . . . . . E. Does the applicant authorize the Comptroller of Maryland and the Comptroller's duly authorized personnel to search without warrant any vehicle, railroad car, vessel, aircraft, or premises used in the business to be conducted under this permit at any and all hours agreeable to the laws of the State of Maryland? . . . . . . . . . . . . . Yes No Yes No F. address of the direct wine shipper, and the consumer who received each delivery? . . . . . . . . . . . . . . . . . . . . . . . . information, and belief. Title Date American LegalNet, Inc. www.FormsWorkFlow.com COM/RAD 383 Rev. 6/11 Common Carrier Permit Application for Direct Wine Shipment Page 2 1. The holder of a common carrier permit may only deliver wine to a Maryland consumer who is at least 21 years of age. 2. The holder of a common carrier permit may only deliver wine to a consumer in the State that is shipped by a direct wine shipper who has a valid Maryland direct wine shipper's permit. Possession of a copy of the requirement. 3. The term of a common carrier permit is one year and begins on July 1st. The permit must be renewed annually. 4. The holder of a common carrier permit shall: a. Complete a delivery of wine to a consumer at the address on the shipping label by obtaining: (i) the signature of the consumer or another individual at the delivery address who is at least 21 years old; and showing that the signing individual is at least 21 years old. b. Refuse delivery of wine to a Maryland consumer when the recipient of the delivery: (i) appears to be under age 21; or c. File a quarterly report with the Comptroller of Maryland, stating the date of each delivery of wine in the State, and the name and address of the direct wine shipper, and the consumer who receives each delivery. d. Maintain for a period of 3 years complete and accurate records of all information needed to verify compliance with the requirements of the Common Carrier Permit. e. Allow the Comptroller of Maryland to perform an audit of the common carrier records on request. 5. One common carrier permit authorizes all deliveries under the permit for the permit year. A separate permit for each truck or vehicle is not required. 6. "Wine" means any fermented beverage, including light wines, and wines the alcohol content of which has ingredients. 7. See Administrative Release No. AB-42 for additional information. 1. Submit the $100.00 annual permit fee with the application. Permit fees are not pro-rated. 3. Make checks payable to "Comptroller of Maryland." 4. Sign, date and mail your application to: Comptroller of Maryland Revenue Administration Division Licensing and Registration P.O. Box 2999 Annapolis, MD 21404-2999 For more information: Telephone: 410-260-7980, 1-888-784-0142 Fax: 410-974-3201 http://compnet.comp.state.md.us http://www.marylandtaxes.com COM/RAD 383 Rev. 6/11 American LegalNet, Inc. www.FormsWorkFlow.com