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Get MI FI-230 2016

____ New Est. or New Location _____ Vending Location: # of machines _____ Special Transitory Food Unit (STFU) Michigan Department of Agriculture & Rural Development As required by Act 92, Public Acts of 2000, as amended For license year ending: Mailing Address (Number & Street, Box or Route) April 30, 2017 License No. L2000ID 6. Applicant Information - MUST BE COMPLETED I certify that this information is accurate Signature Date City State X Zip Code Printed name of owner or autho.

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