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Martin O'Malley, Governor Ch. 353
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(3) ADDRESSES, TELEPHONE NUMBERS, AND THE NAMES OF
CONTACT PERSONS FOR THE FACILITY USED BY THE APPLICANT FOR THE
STORAGE, HANDLING, AND DISTRIBUTION OF PRESCRIPTION DRUGS;
(4) THE TYPE OF BUSINESS FORM UNDER WHICH THE APPLICANT
OPERATES, SUCH AS PARTNERSHIP, CORPORATION, OR SOLE PROPRIETORSHIP;
(5) THE NAME OF EACH OWNER AND OPERATOR OF THE
APPLICANT, INCLUDING:
(I) IF AN INDIVIDUAL, THE NAME OF THE INDIVIDUAL;
(II) IF A PARTNERSHIP, THE NAME OF THE PARTNERSHIP
AND OF EACH PARTNER;
(III) IF A CORPORATION, THE NAME OF THE CORPORATION,
THE NAME AND TITLE OF EACH CORPORATE OFFICER AND DIRECTOR, AND THE
STATE OF INCORPORATION; AND
(IV) IF A SOLE PROPRIETORSHIP, THE FULL NAME OF THE
SOLE PROPRIETOR AND THE NAME OF THE SOLE PROPRIETOR'S BUSINESS
ENTITY;
(6) A LIST OF ALL LICENSES AND PERMITS ISSUED TO THE
APPLICANT BY ANY OTHER STATE THAT AUTHORIZES THE APPLICANT TO
PURCHASE OR POSSESS PRESCRIPTION DRUGS;
(7) FOR THE DESIGNATED REPRESENTATIVE AND THE
IMMEDIATE SUPERVISOR OF THE DESIGNATED REPRESENTATIVE AT THE
APPLICANT'S PLACE OF BUSINESS:
(I) FINGERPRINTS NECESSARY TO CONDUCT A CRIMINAL
HISTORY RECORDS CHECK; AND
(II) THE FOLLOWING:
1. NAME;
2. PLACES OF RESIDENCE FOR THE PAST 7 YEARS;
3. DATE AND PLACE OF BIRTH;
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- 2253 -
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