355 Form NON-PROFIT FESTIVAL PERMIT APPLICATION Beer Festival Liquor Festival Wine Festival $100 $100 $100 To the Comptroller of Maryland, Application is made by the undersigned under the provisions of Article 2B of the Annotated Code of Maryland for the permit indicated above. This application shall be filed with the office of the Comptroller not less than 30 days prior to Non-Profit Festival. Office Use Only 1. 2. Name of Non-Profit organization ______________________________________________ Mailing address: __________________________________________________________ ________________________________________________________________________ 3. 4. 5. Business Telephone no.: ____________________________________________________ Federal tax identification number: _____________________________________________ Attach a copy of your 501(c) determination letter. Approved ______________ Date __________________ Number _______________ Permit Year _____________ Stub Number ___________ 6. 7. The primary purpose of this festival is to promote Maryland beer, liquor or wine . . . . . . . . . . . . . . . . . . . . . . YES NO Provide details of the beer, liquor or wine festival: ______________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ 8. Location: _______________________________________________________________________________________________ Beer, liquor or wine festival dates: _________________________________ Hours of Operation:________________________ 9. Does applicant agree to conform to all laws, rules and regulations of the State of Maryland related to the actions and business activities authorized under this permit? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . YES NO 10. I agree that at all times during the beer, liquor or wine festival the permit holder shall have present at least two agents, one of whom may be the permit holder, who are certified by an approved Alcohol Awareness Program . . YES NO 1. Name ____________________________________________________ Phone Number _____________________________ Name of program ____________________________________________________________________________________ 2. Name ____________________________________________________ Phone Number _____________________________ Name of program ____________________________________________________________________________________ 11. Submit with this application to the Office of Comptroller a list of all off-site permit holders who will attend this festival. PLEASE NOTE: (1) YOU ARE REQUIRED TO NOTIFY THE LOCAL LICENSING BOARD OF THE JURISDICTION IN WHICH THE FESTIVAL WILL BE HELD THAT THE FESTIVAL PERMIT HAS BEEN ISSUED. 12. Must be signed by an officer of the non-profit. AFFIDAVIT I do solemnly declare and affirm under the penalties of perjury that the contents of this document are true and correct to the best of my knowledge, information, and belief. Signature Printed Name 13. This section must be completed by the authorized representative of the festival. CERTIFICATION I hereby certify that I am the authorized representative of the festival stated in this Permit located at ________________________ ___________________________________ , _________________________________________________ , County/City, Maryland, and that I assent to the granting of this Permit to the retail licensee stated on this application, and that I authorize the Comptroller of Maryland, his duly authorized deputies, inspectors and clerks, the Board of License Commissioners of the jurisdiction in which the festival 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 actions and activities under this Permit are to be conducted, at any and all hours. COM-FED/RLS-355 Rev. 06/16 American LegalNet, Inc. www.FormsWorkFlow.com 355 Form NON-PROFIT FESTIVAL PERMIT APPLICATION 14. 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/we are the owner(s) of the property known as _______________________________________________________________ ____________________________________________________________________________________________________ named in 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. Affidavit I do solemnly declare and affirm under the penalties of perjury that the contents of this foregoing document are true and correct to the best of my knowledge, information, and belief. _________________________________________________ Signature of owner, partner or corporate officer __________________________________________________ Type or print name of owner, partner or corporate officer _________________________________________________ Title __________________________________________________ Date Third Party Checks Affidavit I do solemnly declare and affirm under the penalties of perjury that the contents below are true and correct to the best of my knowledge, and that I am authorized and empowered to issue a check and make payment for the license/permit fee on behalf of the applicant. Name of Corporation; Partners of Partnership; or Individual (include Trade Name) Complete Mailing Address Signature of Owner, Partner or Corporate Officer Title Federal Identification Number and/or Social Security Number Date CONTACT INFORMATION: COM-FED/RLS-355 Rev. 06/16 Comptroller of Maryland Field Enforcement Division Regulatory and Licensing Section P.O. Box 2999 Annapolis, Maryland 21404-2999 410-260-7314 or 800-MD-TAXES www.marylandtaxes.com Ame