Date............... 20....
To Be Filled in by Seller
IDENTIFICATION (CHECK ALL SHOWN)
DESCRIPTION OF PURCHASER
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.
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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Height .................................................... | Weight........................ |
Color of Eyes......................................... | Color of Hair.............. |
Outstanding Features............................ | |
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Seller's Signature.......................................... |
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Print full name............................................................... | |
Street address............................................................ | |
City............................................................................. | State............................ |
Signature................................................ |
Md. Code, AB § 4-506