State of Maryland Department of Labor Maryland Board of Examiners of Landscape Architects 1100 N. Eutaw St Baltimore, Maryland 21201 (410) 230-6322 (Baltimore area), (888) 218-5925 (Toll Free) |
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SECTION I
PRINT FIRM NAME |
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BUSINESS ADDRESS |
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CITY | STATE | ZIP CODE |
SECTION II. RESPONSIBLE MEMBER
The Maryland Landscape Architects Act, Business Occupations and Professions Article, §9-404, requires that a corporation / LLC or partnership / LLP shall appoint at least one responsible member of the corporation / LLC or partnership / LLP who shall be in responsible charge of architecture practiced through the corporation / LLC or partnership / LLP. Each responsible member shall be a director of the corporation or a member of an LLC or a partnership/LLP of a licensed Maryland Landscape Architect.
COMPLETE THE REQUIRED INFORMATION BELOW FOR:
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CONFIRMATION OF RESPONSIBILITY MUST BE SIGNED BY PERSONS LISTED ABOVE
I HAVE READ THE CURRENT LICENSING LAW AND I AM FULLY AWARE OF THE CORPORATE/LLC or PARTNERSHIP/LLP RESPONSIBILITIES AS WELL AS MY RESPONSIBILITIES AS AN INDIVIDUAL LICENSEE.
SIGNATURE OF RESPONSIBLE MEMBER | DATE | |
SIGNATURE OF RESPONSIBLE MEMBER | DATE |
CORPORATION / LLC - GO TO SECTION III. PARTNERSHIP / LLP - GO TO SECTION IV.
SECTION III. CORPORATION / LLC - CERTIFICATE OF GOOD STANDING
A Certificate of Good Standing, dated within the preceding thirty (30) days of this
application, issued by the Maryland State Department of Assessments and Taxation, must be
attached to this application. The telephone number for the Department of Assessment and
Taxation is (410) 767-1340.
SECTION IV. CERTIFICATIONS - Must be completed by all applicants. |
a. | I understand that by signing this statement, the permit for
which I am applying will expire on the date printed on the permit, and that I will be
required to renew this permit and pay the renewal fee prior to the above expiration date.
I further understand that I may not engage in the profession for which I have applied
until such time as a permit has been issued to me. |
b. | " I hereby certify, under penalty of perjury, that the information contained herein is true and correct to the best of my knowledge, information, and belief. I further authorize the release of any information contained within this application to an authorized representative of the Department of Labor for further investigation. I further certify that I have paid all undisputed taxes and unemployment insurance contributions payable to the Comptroller or the Department of Labor or have provided for payment in a manner satisfactory to the unit responsible for collection. |
SIGNATURE OF PRESIDENT OF CORPORATION / LLC OR PARTNERSHIP / LLP | DATE |
FOR OFFICE USE ONLY
APPROVED BY: | DATE |
1. 2. 3. 4. 5. |
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DENIED BY: | DATE |
1. 2. 3. 4. 5. |
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REASON FOR DENIAL: |