Direct Wine Shipper’s Permit Application Section 1 - Applicant Information □ New Permit □ Renewal (Permit #) DW- _________ Number ___________________ Corporate Name and T/A of Wine Manufacturer Permit Year ________________ A. Stub Number ______________ Name of Contact B. Phone Number Fax Number Approved _________________ Date ______________________ E-mail address Check Number _____________ Mailing address C. Check Amount $ ___________ Deposit Date _______________ City State Zip If the mailing address is a P.O. Box provide physical location address D. E. Applicant is a: □ Corporation □ □ Partnership - - □ Individual - Social Security Number 1 2 3 Name Home Address Home Phone No. Social Security No. F. The applicant is a person licensed outside the State to engage in the manufacture of wine; or a holder of a Maryland Class 3 manufacturer’s license or a Class 4 manufacturer’s license: (submit a copy of your current license(s)) State of Issuance Type or Class Expiration Date License # G. Section 9-104 of Article 2B of the Annotated Code of Maryland titled “Workers’ Compensation Compliance” requires the □ a. Applicant is not an employer required to provide coverage by the Maryland Workers’ Compensation Law; or □ b. Applicant is an employer required to provide employee coverage by the Maryland Workers’ Compensation Law or binder number: Name of Insurance Company COM/RAD-381 Rev. 6/11 Policy or Binder Number American LegalNet, Inc. www.FormsWorkFlow.com Page 2 Direct Wine Shipper’s Permit Application Section 2 - Permit Information □ Yes □ No B. Has the applicant ever been convicted of a felony by any state or federal court? . . . . . . . . . . . . . . . □ Yes □ No ...................... □ Yes □ No State of Maryland relating to the business proposed under this permit? . . . . . . . . . . . . . . . . . . . . . □ Yes □ No the business to be conducted under this permit at any and all hours agreeable to the laws of the State of Maryland? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . □ Yes □ No on sales to consumers in Maryland? If you check “No approved. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . □ Yes □ No G. Do you have a Federal Basic Permit issued by the Alcohol and Tobacco Tax and Trade Bureau (TTB)? (Submit a copy of your Federal Basic Permit) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . □ Yes □ No H. Do you agree to deliver wine to a Maryland consumer through a common carrier who has been issued a permit by the Comptroller of Maryland? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . □ Yes □ No please provide an explanation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . □ Yes □ No A. Does the applicant have a valid Maryland sales and use tax license? . . . . . . . . . . . . . . . . . . . . . . . If you checked “Yes _________________ If you checked “No with this application. E. Does the applicant authorize the Comptroller of Maryland and the Comptroller’s duly authorized Title COM/RAD-ATT-10-10 Rev. 6/11 Date American LegalNet, Inc. www.FormsWorkFlow.com Page 3 Direct Wine Shipper’s Permit Application Section 4 - Direct Wine Shipper Permit - Requirements 1. The holder of a direct wine shipper's permit may only sell wine to a personal consumer who is at least 21 purchases wine for personal consumption only and not for resale or other commercial purposes. 2. A direct wine shipper's permit entitles the holder to sell its own manufactured wine through the holder of a common carrier permit to a Maryland consumer by by electronic or other means. 3. The term of a direct wine shipper's permit is one year and begins on July 1st. The permit must be renewed annually. e. Allow the Comptroller of Maryland to perform an audit of the direct wine shipper's records on request. of Maryland or other State unit and the State courts concerning enforcement of the Direct Wine Shipper's Permit and any related law. 5. A direct wine shipper may not: a. Ship more than 18 9-liter cases of wine annually to a single delivery address. b. Cause wine to be delivered on Sunday to an address in the State. 4. A direct wine shipper shall: a. Ensure that all containers of wine shipped directly to a consumer in the State are conspicuously labeled with: ingredients. 7. See Administrative Release No. AB-42 for additional information. (i) The name of the direct wine shipper; (ii) The name and address of the consumer who is the intended recipient; and (iii) The words "Contains Alcohol: Signature of Person at Least 21 Years of Age Required for Delivery". Section 5 - Application Instructions 1. Submit the $200.00 annual permit fee with the application. Permit fees are not pro-rated. 3. Make checks payable to “Comptroller of Maryland.” b. File a quarterly alcoholic beverage tax return and a quarterly sales and use tax return with the sales tax and pay alcoholic beverage tax due on sales to consumers in Maryland. The alcoholic beverage tax return must state the total amount Comptroller of Maryland Revenue Administration Division Licensing and Registration P.O. Box 2999 For more information: purchaser. c. Post security for the alcoholic beverage tax in the of-state manufacturer of wine. Existing bonds for Fax: 410-974-3201 http://compnet.comp.state.md.us http://www.marylandtaxes.com d. Maintain for a period of 3 years complete and accurate records of all information needed to verify compliance with the requirements of the Direct Wine Shipper's Permit. COM/RAD-ATT-10-10 Rev. 6/11 American LegalNet, Inc. www.FormsWorkFlow.com