MARYLAND FORM 371-2 STATEWIDE CATERER'S LICENSE CATERED EVENT CERTIFICATE AND NOTICE CATERER INFORMATION Name of Caterer: __________________________________________________________________________________________ Address of Caterer: ________________________________________________________________________________________ ________________________________________________________________________________________________________ Statewide Caterer's License #: _______________________________________________________________________________ CATERED EVENT INFORMATION Name of Person Contracting Catered Event: _____________________________________________________________________ Phone Number of Person Contracting Catered Event: ______________________________________________________________ Name of Organization (if applicable): __________________________________________________________________________ Address/Location of Catered Event: ___________________________________________________________________________ Political Subdivision of Catered Event: _________________________________________________________________________ Date of Catered Event: _____________________________________________________________________________________ Time of Catered Event: _____________________________________________________________________________________ On-Site Manager for Caterer: ________________________________________________________________________________ I hereby certify that this event will be conducted in accordance with Section 6-701 of Article 2B of the Annotated Code of Maryland relating to statewide caterer's license authority, all other provisions of Article 2B relating to the sale and distribution of alcoholic beverages, and all applicable regulations promulgated thereunder. Signature of Statewide Caterer Licensee Date Distribution of Copies Original -Tobefiledandmaintainedonlicensedpremisesofcaterer. Copy -To be conspicuously posted on catered event premises during event. Copy -TobefiledwithlocalBoardofLicenseCommissionersinjurisdictionwheretheeventwillbeconductednolaterthan5days before the event. Contact Information Comptroller of Maryland Revenue Administration Division Licensing & Registration PO Box 2999 Annapolis, MD 21404 410-260-7980 www.marylandtaxes.com COM/RAD 371-2 Rev. 0 /14 American LegalNet, Inc. www.FormsWorkFlow.com