STATE OF MARYLAND
Department of Labor, Licensing and Regulation
Secondhand Precious Metal Object Dealers / Pawnbrokers
500 N. Calvert St., Room 304
Baltimore, Maryland 21202-3651
(410) 230-6222 (Baltimore area), or (888) 218-5925 (Toll Free)

Application To Change Business Name

SECTION 1. INSTRUCTIONS FOR APPLICANTS
1. The dealer / pawnbroker must complete this form. All information must be typewritten or clearly printed in ink. Incomplete forms will not be accepted. Mail the completed form and all other required documents to the above address.
2. Corporate licensees or applicants must submit the following with this application:
  1. a copy of the Articles of Incorporation of the business
  2. 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. The telephone number for the Department of Assessment and Taxation is (410) 767-1340.
3. If you are also changing the business location you must file a separate "Application to Transfer License to a New Business Location" with the Secretary of the Department.
4. You may not conduct business under the new business, corporate or trade name until you receive written approval of the change of name from the Secretary of the Department of Labor, Licensing and Regulation.

SECTION 2. DEALER'S INFORMATION
Dealer's Name (Last, First, M.I.):
 
Home Address:
 
City, State, Zip: 
Registration Number:     Social Security No.: 
Home Telephone No.:     E-mail Address: 

SECTION 3. DEALER BUSINESS INFORMATION
Current Business Name:
 
Business Address:
 
City, State, Zip: 
County:     Bus. Telephone No.: 
E-mail: 

SECTION 4. NEW BUSINESS NAME
I hereby request the Secretary of the Department of Labor Licensing and Regulation for permission to change the business, corporate or trade, name which appears on my license. I have applied to and received approval from the Department of Assessments and Taxation under Article 2, Section 18, Annotated Code of Maryland to use the following name.

New Business Name:
 
Check one of the following options:
  The business will be operated at the current location indicated on my license.
  The business will be operated at a new location and I have applied / am applying for permission from the Secretary of the Department to move my business.

SECTION 5. QUESTIONS AND CERTIFICATIONS
Since receiving your last license (circle the correct answers):
1. Have you ever been convicted of a felony or misdemeanor in any State or Federal court? Yes No
2. Have you ever had this type of license denied, suspended, or revoked by Maryland or any other State? Yes No
3. Have you been convicted of or received probation before judgement of any drug offense committed after January 1,1991? Yes No

    If you have answered yes to any of the above questions, you must submit the following:

    • A typed letter giving a complete explanation of the incident(s)
    • A true test copy of the applicable court document(s)
    • A copy of the final order in your case(s)

    Please mail these documents to the above address.

    APPLICANT'S AFFIDAVIT

    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 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 Applicant    

    Date Signed



    FOR OFFICE USE ONLY
    Date Received:
    APPROVED BY:
       Date
    DENIED BY:
       Date
    REASON FOR DENIAL: