State of Maryland Department of Labor, Licensing and Regulation
Maryland Board of Examiners of Landscape Architects
500 N. Calvert St., Room 308
Baltimore, Maryland 21202
(410) 230-6322 (Baltimore area),    (888) 218-5925 (Toll Free)

Landscape Architect - Application for Permit for Corporation or Partnership

SECTION I


PRINT FIRM NAME
BUSINESS ADDRESS 
STREET NAME AND NUMBER
CITY STATE ZIP CODE

SECTION II. RESPONSIBLE MEMBER

The Maryland Landscape Architects Act, Business Occupations and Professions Article, 9-404, requires that a corporation or partnership shall appoint at least one responsible member of the corporation or partnership who shall be in responsible charge of architecture practiced through the corporation or partnership. Each responsible member shall be a director of the / or member of an or a partner of the partnership and a licensed Maryland Landscape Architect.

COMPLETE THE REQUIRED INFORMATION BELOW FOR:

Name and position of responsible member(s)  Maryland License Number

CONFIRMATION OF RESPONSIBILITY MUST BE SIGNED BY PERSONS LISTED ABOVE

I HAVE READ THE CURRENT LICENSING LAW AND I AM FULLY AWARE OF THE PARTNERSHIP/CORPORATE RESPONSIBILITIES AS WELL AS MY RESPONSIBILITIES AS AN INDIVIDUAL LICENSEE.

SIGNATURE OF RESPONSIBLE MEMBER  DATE
SIGNATURE OF RESPONSIBLE MEMBER  DATE

CORPORATION - GO TO SECTION III. PARTNERSHIP - GO TO SECTION IV.


SECTION III. CORPORATION - 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.

GO TO SECTION IV

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, Licensing and Regulation 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, Licensing and Regulation or have provided for payment in a manner satisfactory to the unit responsible for collection.
SIGNATURE OF PRESIDENT OF CORPORATION OR PARTNERSHIP  DATE




FOR OFFICE USE ONLY

APPROVED BY: DATE
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DENIED BY: DATE
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REASON FOR DENIAL: