Form Com/att-10-7 - Application For National Family Beer And/or Wine Exhibition Permit
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1
2Comptroller of Maryland
Office Use Only
Office Use Only
MATT Regulatory Division
Check No.
Number
Alcohol and Tobacco Tax
Check Amt.
Stub
P.O. Box 2999
Deposit Date
Year
Annapolis, Maryland 21404-2999
410-260-7314 or 888-784-0145
Approved
Application for National Family Beer
Date
and/or Wine Exhibition Permit
Section 1
A. Name of Non-Profit National Family Beer and/or Wine Association:
B. Mailing Address:
C. Telephone Number with Area Code:
Fax Number:
—
D. Federal Identification Number:
E. Premises in Maryland where event is to be held:
Yes G
No G
F. Is this a retail alcoholic beverage license premise:
G. Date(s) event is to be conducted:
Section 2
.......................................... Yes G
No G
A. Has the applicant ever been convicted of a felony by any state or Federal Court?
B. Does the applicant agree to confirm to all the laws, rules, and regulations of the state of Maryland relating to the
business which is proposed to be engaged in under this permit? ....................................................................... Yes G
No G
C. Does the applicant authorize the Comptroller of Maryland and his duly authorized personnel to search without
warrant any vehicle, railroad cars, 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 G
No G
D. Has the applicant ever been convicted of a violation of the laws of the United States, Maryland, or any other state
concerning alcoholic beverages, gaming, or gambling?
(If yes, explain in detail on separate paper - list offense, court, date, etc.) ......................................................... Yes G
No G
E. Section 9-104 of Article 2B of the Annotated Code of Maryland titled “Workers' Compensation Compliance” requires the evidence
of such compliance prior to the issuance of any permit by this office. The applicant hereby affirms (complete one):
a. Applicant is not an employer required to provide coverage by the Maryland Workers' Compensation Law; or
b. is an employer required to provide employee coverage by the Maryland Workers' Compensation Law and has
secured such coverage. As evidence of such coverage, the following is submitted:
1. Name of Insurance Company:
2. Policy or Binder Number:
COM/ATT-10-7
Rev. 7/07
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