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Get State Of Michigan Lcc 3010

Michigan.gov/lcc Business ID Request ID For MLCC use only Report of Stockholders/Members/Partners Authorized by MCL 436. 1529 1 R 436. 1051 and R 436. 1110 Name and Registered Address of Entity Name of entity Address City State Zip Corporations - Please complete this section and attach more copies of this page if more room is needed. Name and address of all stockholders Certificate Numbers Shares Issued Date Issued/Acquired Limited Liability Companies - Please complete this section and attach more copies of this page if more room is needed. Percent Issued Date Issued/Acquired LCC-3010 06/14 LARA is an equal opportunity employer/program. Auxiliary aids services and other reasonable accommodations are available upon request to individuals with disabilities. 1529 1 R 436. 1051 and R 436. 1110 Name and Registered Address of Entity Name of entity Address City State Zip Corporations - Please complete this section and attach more copies of this page if more room is needed. Name and address of all stockholders Certificate Numbers Shares Issued Date Issued/Acquired Limited Liability Companies - Please complete this section and attach more copies of this page if more room is needed. Percent Issued Date Issued/Acquired LCC-3010 06/14 LARA is an equal opportunity employer/program. Auxiliary aids services and other reasonable accommodations are available upon request to individuals with disabilities. Page 1 of 2 Limited Partnerships - Please complete this section and attach more copies of this page if more room is needed. Signature of Applicant I certify that the information contained in this form is true and accurate to the best of my knowledge and belief. I agree to comply with all requirements of the Michigan Liquor Control Code and Administrative Rules. I also understand that providing false or fraudulent information is a violation of the Liquor Control Code pursuant to MCL 436. Michigan Department of Licensing and Regulatory Affairs Liquor Control Commission MLCC Constitution Hall - 525 W* Allegan Lansing MI 48933 Mailing Address PO Box 30005 Lansing MI 48909 Toll Free 866 813-0011 www. michigan*gov/lcc Business ID Request ID For MLCC use only Report of Stockholders/Members/Partners Authorized by MCL 436. Page 1 of 2 Limited Partnerships - Please complete this section and attach more copies of this page if more room is needed* Signature of Applicant I certify that the information contained in this form is true and accurate to the best of my knowledge and belief* I agree to comply with all requirements of the Michigan Liquor Control Code and Administrative Rules. I also understand that providing false or fraudulent information is a violation of the Liquor Control Code pursuant to MCL 436. Michigan Department of Licensing and Regulatory Affairs Liquor Control Commission MLCC Constitution Hall - 525 W* Allegan Lansing MI 48933 Mailing Address PO Box 30005 Lansing MI 48909 Toll Free 866 813-0011 www. michigan*gov/lcc Business ID Request ID For MLCC use only Report of Stockholders/Members/Partners Authorized by MCL 436.

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