Date............... 20....
To Be Filled in by Seller
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IDENTIFICATION (CHECK ALL SHOWN)
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Driver's License.................................... | [] | Army I.D. Card............................................. | [] |
Birth Certificate..................................... | [] | Coast Guard I.D. Card............................... | [] |
Service Discharge............................... | [] | Marine I.D. Card......................................... | [] |
Draft Card............................................. | [] | Navy I.D. Card............................................. | [] |
Air Force I.D. Card............................... | [] | ||
Other (Specify)............................................................ |
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DESCRIPTION OF PURCHASER
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Height............................................................ | Weight.............................. |
Color of Eyes ............................................... | Color of Hair....................... |
Outstanding Features....................................................... | |
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Seller's Signature.............................................................................................................. |
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To Be Filled in by Prospective Purchaser
I declare I am of legal age to purchase fermented malt beverages or intoxicating liquor, and that I am subject to arrest and prosecution for misrepresenting my age
Print full name............................................................ | |
Street address............................................................. | |
City...................................................................... | State.............................. |
Signature................................................................. |
Md. Code, AB § 3-505