Temporary Business Modification Event Permit

STATE OF MARYLAND

MONTGOMERY COUNTY

Alcohol Beverage Services

APPLICATION FOR
TEMPORARY BUSINESS MODIFICATION PERMIT

LICENSEE DETAILS

LICENSEE EMAIL ADDRESS*

LICENSE NUMBER*

LICENSEE NAME*

LICENSEE PHONE*

FACILITY NAME*

FACILITY ADDRESS*

Address Line 1

Address Line 2

City

State

ZIP Code

APPROVED?

YES

EVENT DETAILS

EVENT NAME*

DESCRIBE REASON FOR TEMPORARY BUSINESS MODIFICATION*

WILL THERE BE HIRED SECURITY?*

YES NO

SECURITY COMPANY NAME*

SECURITY CONTACT NAME*

SECURITY CONTACT PHONE*

NUMBER OF DAYS OF EVENT*

EVENT DATE*

EVENT HOURS FROM*

EVENT HOURS TO*

EVENT DATE*

EVENT HOURS FROM*

EVENT HOURS TO*

EVENT DATE*

EVENT HOURS FROM*

EVENT HOURS TO*

EVENT DATE*

EVENT HOURS FROM*

EVENT HOURS TO*

EVENT DATE*

EVENT HOURS FROM*

EVENT HOURS TO*

DOCUMENTATION

All temporary business modifications must submit an Alcohol and Security Plan.

This plan should include how you will be serving/selling alcohol (bartender, sectioned off beer garden, etc.), who will be checking ID's, how drinks will be sold (tickets, cash bar, etc.), how will people under the age of 21 be differentiated between those who are 21 years old and over.

ALCOHOL PLAN*

SECURITY PLAN*

FOOD AND ALCOHOL MENU

FLOOR PLAN*

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LICENSEE SIGNATURE

I understand landlord approval is required as well as any other County regulatory agency that may be impacted by the temporary extension of the licensed premises. As always, adherence to to the Board of License Commissioners Rules and Regulations is required to ensure responsible sales and service of alcoholic beverages.

By signing this report, I do solemnly declare and affirm under the penalties of perjury, that the contents of the foregoing report are true and correct to the best of my knowledge, information and belief.

LICENSEE SIGNATURE*

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Progress

STATE OF MARYLANDMONTGOMERY COUNTY

APPLICATION FORTEMPORARY BUSINESS MODIFICATION PERMIT

LICENSEE DETAILS

EVENT DETAILS

DOCUMENTATION

LICENSEE SIGNATURE

STATE OF MARYLAND

MONTGOMERY COUNTY

APPLICATION FOR
TEMPORARY BUSINESS MODIFICATION PERMIT