386 Form INTENT TO PARTICIPATE IN AN OFF-SITE EVENT FORM No later than the 20th day of the month preceding the off-site event, the holder of an Off-Site permit shall notify the Office of the Comptroller of it's intention to attend an off-site event. EVENT TYPE Farmer's Market Wine Festival North Beach Friday Night Farmer's Market Montgomery County Agricultural Fair Other Off Site Event Name of Winery / Brewery ______________________________________________________________________________ Off-site Permit Number _______________________________________________________________________________ Event Name ________________________________________________________________________________________ Event Venue Name ___________________________________________________________________________________ Event Venue Address, include county ____________________________________________________________________ __________________________________________________________________________________________________ Date/s of Event _____________________________________________________________________________________ Hours of Operation ___________________________________________________________________________________ Name of non-profit __________________________________________________________________________________ Wine Festival Permit Number___________________________________________________________________________ Event Organizer's Name ______________________________________________________________________________ Full description of Event - give details ____________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ This section must be completed by the owner of the premises where the event will take place. 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 the property known as ___________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ named as the foregoing application made to the Comptroller of Maryland under the Alcoholic Beverages Law of Maryland; that I/we assent to the granting of the permit 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 jurisdiction in which the place of business is located, its duly authorized agents and employees, and any peace officer of such jurisdiction to inspect and search, without warrant, the premises upon which the business is to be conducted, and any and all parts of the building in which said business is to be conducted, at any and all hours. COM/RAD-386 13-49 07/15 American LegalNet, Inc. www.FormsWorkFlow.com 386 Affidavit Form INTENT TO PARTICIPATE IN AN OFF-SITE EVENT FORM Page 2 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. Signature Type or print name Title Date Contact Information Comptroller of Maryland Revenue Administration Center Licensing and Registration P.O. Box 2999 Annapolis, Maryland 21404-2999 410-260-7980 or 800-MD-TAXES www.marylandtaxes.com COM/RAD-386 13-49 07/15 American LegalNet, Inc. www.FormsWorkFlow.com