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FOOD FACILITY LICENSE APPLICATION - RENEWALS ONLY

Corporate Name:
Officer/Owner Name:
Title:
Trade Name: *    
Business Address1: *  
Business Address2:
City:
State:    ZipCode:
Business Telephone:
Home/Mobile Telephone:
Owner's Home Address1:
Owner's Home Address2:
City:
State:    ZipCode:
Mailing address
(if different than business):
Email: *  

REQUIRED FEES BASED ON FACILITY TYPE/PRIORITY *
(Your plan reviewer will assess your facility and assign a type/priority)







COMPLIANCE WITH THE MARYLAND WORKERS’ COMPENSATION ACT
NOTICE:
Maryland annotated code, health general article, section 1-202 requires that before any license or permit is issued to an employer to engage in an activity in which the employer may employ a covered individual, the employer must file with the issuing authority a certificate of compliance with the state workers compensation laws; or the employer’s worker’s compensation insurance policy or binder number.

  • Allowed file types: .zip,.rar,.doc,.docx,.jpg,.png,.tiff,.tif,.xls,.xlsx,.pdf
  • Allowed file size: 5MB
  • Invalid characters in the filename ~, `, !, #, $, %, ^, /, \, ', =, , , [, ], {, }, —, —, …

 
STATEMENT OF WASTE HAULER SERVICE
All food facilities are required to have waste disposed of daily or as often as necessary to prevent a nuisance or unsanitary condition by a method that complies with applicable state and local laws, regulations, and ordinances.
CHECK THE OPTION BELOW WHICH APPLIES TO YOU AND PROVIDE THE REQUESTED INFORMATION:*  

STATEMENT OF TOBACCO LICENSEE
Complete this section if you hold a state of Maryland license to sell tobacco-containing products or intend to apply for one.
State of Maryland license number(if known):

Place your initials next to each of the following statements to indicate your understanding:
* The sale of cigarettes, other tobacco products, and electronic smoking devices to anyone under the age of 18 is illegal― even if they claim to be buying them for an adult, even if they have a note. Photo id must be requested from any person who appears to be younger than 27.
* The sale of individual cigarettes is illegal. No “loosies” or partial packs may be sold. Cigarette packs must be sold in a minimum package of 20.
* The placement of tobacco products and electronic smoking devices must be done in such a manner that they cannot be reached by any person under the age of 18.
* It is my responsibility to ensure that all staff are aware of and understand these rules prior to allowing them to sell any merchandise of any kind to customers.

  I certify that the above information is correct to the best of my knowledge and belief.

M & T bank, in partnership with Online Resources, is now able to facilitate making real property Part Year tax payments via a direct debit to your personal/business checking account or credit card. Please note that personal/business savings accounts will not be accepted.


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