On-Premises Retailer License & Permit Application

Michigan Department of Licensing and Regulatory Affairs

Liquor Control Commission (MLCC)

Toll-Free: 866-813-0011 - www.michigan.gov/lcc

Before you begin filling out the attached application, please review this checklist for the applicable forms and documents you

will need to submit with your completed application form.

The attached LCC-100a form will automatically calculate fees when opened using Adobe Acrobat Reader. The form's

functionality may not work with third-party PDF readers. You may download a free copy of Adobe Acrobat Reader on the Adobe

website:

https://get.adobe.com/reader/

Completed On-Premises Retail License & Permit Application (Form LCC-100a, attached)

Livescan Fingerprint Form (LCC-105)* (attached)

Inspection, License, and Permit Fees

Local Government Authorization (Form LCC-106) - For a new on-premises license only

Purchase agreement - For the transfer of ownership of a license

Property document (lease, deed, land contract, etc.)

New On-Premises Resort License Questionnaire (LCC-109a) or New On-Premises Redevelopment or Development District

License Questionnaire (LCC-109b) - For a new on-premises Resort, Redevelopment, or Development District license only

*Fingerprints are required for applicants that are not currently licensed by the MLCC and will hold 10% or more interest in a license or

applicant entity.

If applicant is a corporation also include (pursuant to R 436.1109):

If any of the stockholders of the applicant are corporations or limited liability companies, also submit a copy of the documents listed below for those

companies (except for the Certificate of Authority to Do Business in Michigan, which is required for the applicant only).

Copy of the operating agreement or bylaws of the applicant company

Copy of Articles of Organization filed with the Corporations Division of the Department of Licensing & Regulatory Affairs

If applicant is a limited liability company also include (pursuant to R 436.1110):

If any of the members of the applicant are corporations or limited liability companies, also submit a copy of the documents listed below for those companies

(except for the Certificate of Authority to Do Business in Michigan, which is required for the applicant only).

Copy of Articles of Incorporation filed with the Corporations Division of the Department of Licensing & Regulatory Affairs

Report of Stockholders/Member/Partners (Form LCC-301)

Certified copy of the minutes of a meeting of its board of directors or a statement signed by an officer of the corporation

naming the persons authorized by corporate resolution to sign the application and other documents required by the

Commission or Part 3 of Form LCC-301.

Statement signed by a manager of the limited liability company or by at least 1 member if management is reserved to

the members naming the person authorized to sign the application and other documents required by the Commission

or Part 3 of Form LCC-301.

Report of Stockholders/Member/Partners (Form LCC-301)

Current Certificate of Good Standing from the state where incorporated and Certificate of Authority to Do Business in

Michigan, if incorporated outside of Michigan.

Current Certificate of Authority to Do Business in Michigan, if the LLC is a non-Michigan LLC.

Are you transferring stock or

membership interest? If yes, use

the License Interest Transfer

Application (LCC-101).

Corporate Documents (see list below) - Submit for the applicant company, and if the applicant company has multiple levels of

ownership structure in which stockholders or members are also companies, submit the applicable documents listed below for

any stockholder or member companies to the third tier of ownership - for example: applicant company (tier 1)> stockholder/

member (tier 2) > stockholder/member (tier 3).

Multi-Tier Organizational Chart - If the applicant company has more than three levels of ownership structure please provide an

organizational chart that shows all the levels of ownership to individual people, including trusts.

Off-Premises Retailers: If you are applying for a Specially Designated Merchant (SDM) and/or Specially Designated Distributor (SDD) license for

off-premises sales of alcoholic liquor only, please use the Off-Premises Retailer License & Permit Application (LCC-100b).

Michigan Department of Licensing and Regulatory Affairs

Liquor Control Commission (MLCC)

Toll-Free: 866-813-0011 - www.michigan.gov/lcc

Business ID:

Request ID:

(For MLCC Use Only)

On-Premises Retailer License & Permit Application (LCC-100a)

Part 1 - Applicant Information

Individuals, please state your legal name. Corporations or Limited Liability Companies, please state your name as it is filed with the State of Michigan Corporation Division.

Applicant name(s):

Address to be licensed:

City: Zip Code:

City/township/village where license will be issued:

County:

1. Are you requesting a new license?

3. Are you buying an existing license?

4. Are you transferring the classification of an existing on premises license?

6. Are you transferring the location of an existing license?

7. Is this license being transferred as the result of a default or court action?

8. Do you intend to use this license actively?

2. Are you applying ONLY for a new permit or permission?

Yes No

Yes

Yes No

Part 2 - License Transfer Information (If Applicable)

If transferring ownership of a license ONLY and not transferring the location of a license, fill out only the name of the current licensee(s)

Current licensee(s):

Current licensed address:

City: Zip Code:

City/township/village where license is issued:

County:

Part 3 - Licenses, Permits, and Permissions

Applicants for on premises licenses, permits, and permissions (e.g. restaurants, hotels, bars, etc.) must complete the attached Schedule A and return it

with this application. Transfer the fee calculations from the Schedule A to Part 4 below.

Part 4 - Inspection, License, and Permit Fees - Make checks payable to State of Michigan

Inspection Fees - Pursuant to MCL 436.1529(4) a nonrefundable inspection fee of $70.00 shall be paid to the Commission by an applicant or licensee at

the time of filing of a request for a new license or permit, a request to transfer ownership or location of a license, a request to increase or decrease the size

of the licensed premises, or a request to add a bar. Requests for a new permit in conjunction with a request for a new license or transfer of an existing

license do not require an additional inspection fee.

License and Permit Fees - Pursuant to MCL 436.1525(1), license and permit fees shall be paid to the Commission for a request for a new license or permit

or to transfer ownership or location of an existing license.

Inspection Fees: License & Permit Fees: TOTAL FEES:

Page 1 of 4

LARA is an equal opportunity employer/program. Auxiliary aids, services and other reasonable accommodations are available upon request to individuals with disabilities.

5. Are you modifying the size of the licensed premises?

NoYes

Federal Employer Identification Number (FEIN):

Leave Blank - MLCC Use Only

Yes No

Adding Space Dropping Space Redefining Licensed PremisesIf Yes, specify:

Yes No

LCC-100a (05-23)

Sunday Sales Permit (PM)**

Catering Permit $100.00

Outdoor Service

Entertainment Permit

Dance Permit

Topless Activity Permit

Specific Purpose Permit:

Living Quarters Permit

Extended Hours Permit:

Dance Entertainment

Additional Bar(s)

Number of Additional Bars:

Days/Hours requested:

Days/Hours:

B-Hotel or Class C licenses allow licensees to have one (1) bar within the licensed

premises. A $350.00 licensing fee is required for each additional bar over the one

(1) bar initially issued with the license.

Banquet Facility Permit - Complete Form LCC-200

Schedule A - Licenses, Permits, & Permissions

Brewpub License $100.00

Class C License $600.00

B-Hotel License $600.00

Resort License Upon Licensure

A-Hotel License $250.00

DDA/Redevelopment License Upon Licensure

Tavern License $250.00

G-1 License $1,000.00

G-2 License $500.00

Aircraft License $600.00

Watercraft License $100.00

Train License $100.00

Continuing Care Retirement Center License $600.00

Activity requested:

No charge

A Banquet Facility Permit is an extension of the license at a different location.

It may have its own permits and permissions.

Inspection, License, Permit, & Permission Fee Calculation

Number of Licenses:

x $70.00 Inspection Fee

Total Inspection Fee(s):

Total License Fee(s):

Total Permit Fee(s):

TOTAL FEES DUE:

Make checks payable to State of Michigan

Number of guest rooms:

Page 2 of 4

LARA is an equal opportunity employer/program. Auxiliary aids, services and other reasonable accommodations are available upon request to individuals with disabilities.

Please note that requests to transfer SDD licenses will require the payment

of additional fees based on the seller's previous calendar year's sales. These

fees will be determined prior to issuance of the license to the applicant.

Applicant name:

TransferNew

Fee Code

MLCC Use

Only

Base Fee:On-Premises License Type:

B-Hotel or Class C Licenses Only:

Base Fee:On-Premises Permits:

Sunday Sales Permit (AM)* $160.00

Social District Permit $250.00

No charge

MCL 436.1545(1)(b)(ii)MCL 436.1545(1)(b)(i)

No chargeMotor Vehicle Fuel Pumps

Off-Premises Storage

Direct Connection(s)

On-Premises Public Swimming Pool Permit -

Complete Form LCC-209

No charge

SDM License $100.00

SDD License $150.00

Base Fee:

New Transfer

Off-Premises License Type:

Fee Code

MLCC Use

Only

SDD Sunday Sales Permit (PM)** $22.50

For Spirit Products

Off Premises Permits: Base Fee:

SDM Sunday Sales Permit (PM)** $15.00

For Mixed Spirit Drink Products

*Sunday Sales Permit (AM) allows the sale of spirits, mixed spirit drink, beer, and

wine on Sunday mornings between 7:00am and 12:00 noon, if allowed by the local

unit of government.

**Sunday Sales Permit (PM) allows the sale of spirits and mixed spirit drink on

Sunday afternoons and evenings between 12:00 noon and 2:00am (Monday

morning), if allowed by the local unit of government. No Sunday Sales Permit (PM)

is required for the sale of beer and wine on Sunday after 12:00 noon. The Sunday

Sales Permit (PM) fee is 15% of the fee for the license that allows the sale of spirits

or mixed spirit drink. Additional bar fees and hotel room fees are also calculated as

part of the permit fee. A separate Sunday Sales Permit (PM) is required for each

license that will sell spirits or mixed spirit drink on Sunday after 12:00 noon.

Fee Code

MLCC Use

Only

Pursuant to MCL 436.1533, on-premises retailers may be issued a Specially Designated

Merchant (SDM) license or a Specially Designated Distributor (SDD) license at the same

location in conjunction with the on-premises license under certain circumstances.

Licenses, permits, and permissions selected on this form will be investigated

as part of your request. Please verify your information prior to submitting

your application, as some licenses, permits, or permissions cannot be added

to your request once the application has been sent out for investigation by

the Enforcement Division.

LCC-100a (05-23)

Page 3 of 4

LARA is an equal opportunity employer/program. Auxiliary aids, services and other reasonable accommodations are available upon request to individuals with disabilities.

Part 5a - Information on Individual Applicant, Stockholder, Member, or Limited Partner

Each individual, stockholder, member, or partner must complete Part 5a, 5b, and 5c. If a stockholder or member of an applicant company is a corporation

or limited liability company, complete Part 5a and 5c and submit a completed Form LCC-301. For applications with multiple individuals, stockholders,

members, or partners - each person or entity must complete a separate copy of this page.

Name:

Home address:

City: Zip Code:

Business Phone: Cell Phone:

Email:

State:

Have you ever been licensed by the Michigan Liquor Control Commission (MLCC) or do you currently hold an interest in any other licenses

issued by the MLCC? If Yes, please list business ID numbers below. If you hold interest in 2 or more locations under the same name, please

also write "chain" below. Pursuant to MCL 436.1603, a retailer licensee may not hold interest in a manufacturer or wholesaler licensee.

NoYes

Part 5b - Personal Information (Individuals) - Must be at least 21 years of age, pursuant to administrative rule R 436.1105(1)(a).

Date of Birth:

Social Security Number: Driver's License Number:

Are you a citizen of the United States of America?

Is your spouse a citizen of the United States of America?

Have you ever legally changed your name?

NoYes

If you answered "yes", please list your prior name(s) (including maiden):

Spouse's full name (if currently married):

Spouse's date of birth:

Yes No

Do you or your spouse hold any position, either by appointment or election, which involves the duty to enforce any penal

law of the United States of America, or the penal laws of the State of Michigan, or any penal ordinance or resolution of any

municipal subdivisions of the State of Michigan?

Yes No

Does your spouse hold a retailer, manufacturer, or wholesaler license issued by the MLCC?

Yes No

Have you ever been found guilty, pled guilty, or pled no contest to a criminal charge or any

local ordinance violations? If Yes, list below (attach additional pages if necessary):

Disposition

Has your spouse ever been found guilty, pled guilty, or pled no contest to a criminal charge or any local

ordinance violations? If Yes, list below (attach additional pages if necessary):

Yes No

Date City/State Charge Disposition

Yes No

Part 5c - Signature

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 436.2003. (This form must be signed by the person whose information it contains).

Print Name Signature Date

ChargeCity/StateDate

Do you hold 10% or more interest in the applicant entity?

If you answered "no" to the first question and "yes" to the second question, you must submit fingerprints and undergo an investigation by the MLCC. Please see the

attached instructions for submitting fingerprints to the MLCC. You must submit a copy of the completed and endorsed Livescan Fingerprint Background Request

(LCC-105) with your application.

Full disclosure of criminal history must be reported, regardless of how long ago the crime occurred. State of Michigan and federal

criminal background records will be checked to verify criminal history. Failure to report criminal history charges and/or local ordinance

violations may result in the denial of the application. Criminal history includes felonies, misdemeanors, and local ordinance violations in

Michigan or any other state for which the applicant or applicant's spouse was found guilty, pled guilty, or pled no contest.

LCC-100a (05-23)

Page 4 of 4

LARA is an equal opportunity employer/program. Auxiliary aids, services and other reasonable accommodations are available upon request to individuals with disabilities.

Part 6 - Contact Information For This Application

Part 7 - Attorney Information (If You Have An Attorney Representing You For This Application)

Contact name:

Mailing address:

Fax number:Phone: Email:

Relationship:

What is your preferred method of contact?

What is your preferred method for receiving a Commission Order?

Phone Mail FaxEmail

Member Number: P-Attorney name:

Attorney address:

Fax number:Phone: Email:

Would you prefer that we contact your attorney for all licensing matters related to this application?

Would you prefer any notices or closing packages be sent directly to your attorney?

Mail Email Fax

NoYes

Yes No

Part 8 - Signature of Applicant

Be advised that the information contained in this application will only be used for this request. This section will need to be

completed for each subsequent request you make with this office.

Notice: When purchasing a license, a buyer can be held liable for tax debts incurred by the previous owner. Prior to committing to the purchase of any

license or establishment, the buyer should request a tax clearance certificate from the seller that indicates that all taxes have been paid up to the date of

issuance. Obtaining sound professional assistance from an attorney or accountant can be helpful to identify and avoid any pitfalls and hidden liabilities

when buying even a portion of a business. Sellers can make a request for the tax clearance certificate through the Michigan Department of Treasury.

Under administrative rule R 436.1003, the licensee shall comply with all state and local building, plumbing, zoning, sanitation, and health laws, rules, and

ordinances as determined by the state and local law enforcements officials who have jurisdiction over the licensee. Approval of this application by the

Michigan Liquor Control Commission does not waive any of these requirements. The licensee must obtain all other required state and local licenses,

permits, and approvals for this business before using this license for the sale of alcoholic liquor on the licensed premises.

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 436.2003.

The person signing this form has demonstrated that they have authorization to do so and have attached appropriate documentation as proof.

DateSignature of ApplicantPrint Name of Applicant & Title

Please return this completed form along with corresponding documents and fees to:

Michigan Liquor Control Commission

Mailing address: P.O. Box 30005, Lansing, MI 48909

Overnight deliveries: 2407 N. Grand River Avenue, Lansing, MI 48906

Fax to: 517-284-8557

City: State: Zip Code:

LCC-100a (05-23)

Michigan Department of Licensing and Regulatory Affairs

Liquor Control Commission (MLCC)

Toll-Free: 866-813-0011 - www.michigan.gov/lcc

Livescan Fingerprint Background Request

Instructions for Michigan & Out-of-State Applicants

APPLICANTS THAT LIVE IN MICHIGAN

Applicants for a Michigan liquor license must have their fingerprints a law enforcement agency in Michigan that offers digital

fingerprinting or a private Livescan vendor approved by the Michigan State Police. You may access a list of approved vendors on the

Michigan State Police website (contains vendors' websites and contact information):

https://www.michigan.gov/msp/services/Live-Scan-Vendors.

On the attached Livescan Fingerprint Background Request form, you must use the correct Code (LL), Agency ID Number

(1479J), and Agency Name (MI DEPT OF LICENSING AND REGULATORY AFFAIRS - LIQUOR CONTROL) in order for the

fingerprint report to be sent to the Michigan Liquor Control Commission. Payment receipts should not be mailed to the office,

but kept for your own records.

You must bring the Livescan Fingerprint Background Request form with a driver's license or other state or federal-issued picture

identification to your fingerprint appointment. You will also be required to pay a separate fee to the fingerprint agency when

registering and/or scheduling your appointment. A copy of the Livescan Fingerprint Background Request form, which is signed by

the Livescan Operator and returned to you, must be submitted with your application in order for your request to be investigated.

When your fingerprints are taken, a technician will perform a scan of your fingerprints and submit the data electronically to the

Michigan State Police.

APPLICANTS THAT LIVE OUTSIDE OF MICHIGAN

Applicants for a Michigan liquor license that live outside of Michigan must submit fingerprints through one of the private Livescan

vendors approved by Michigan State Police that offer fingerprinting for residents that live outside of Michigan. You may access a list

of approved vendors that process finger print cards for non-Michigan residents on the Michigan State Police website (contains

vendors' websites and contact information): https://www.michigan.gov/msp/services/Live-Scan-Vendors.

The applicant must contact a local law enforcement agency, governmental agency, or private fingerprint agency to perform ink

fingerprinting on a FBI fingerprint card (FD-258) or fingerprint cards from any other state or local agency (fingerprint cards must be on

card stock). These fingerprint cards must be submitted for processing to one of vendors on the Michigan State Police's list of

approved vendors. Contact the vendor directly regarding its process and the fee for submitting the fingerprint cards for processing.

Make a copy of the completed and signed Livescan Fingerprint Background Request form and submit that copy with the license

application.

WHAT HAPPENS AFTER FINGERPRINTS ARE SUBMITTED

The law enforcement agency or private vendor will submit your fingerprints to the Michigan State Police for analysis.

If no criminal history is found, the Michigan Liquor Control Commission will be notified.

If criminal history is found, the Michigan State Police will send the record directly to the Michigan Liquor Control Commission for

review.

QUESTIONS AND ADDITIONAL INFORMATION

For questions about the Livescan fingerprinting process, call the Michigan State Police at 517-241-0606.

An applicant may request a copy of his or her Criminal History Record Information (CHRI) response and may challenge the accuracy or

completeness of any entry on the CHRI. Please see the next page for information on how to request a copy of a CHRI and for the

appeal process for challenging or correcting a CHRI response entry.

Please note: Fingerprints taken for any other agency will not fulfill fingerprint requirements for a liquor license in Michigan.

LARA is an equal opportunity employer/program. Auxiliary aids, services and other reasonable accommodations are available upon request to individuals with disabilities.

LCC-105 (12-20)

RI-030 (10/2020)

Michigan State Police

AUTHORITY: MCL 28.162, MCL 28.214, MCL 28.248, & MCL 28.273

COMPLIANCE: Voluntary. However, failure to complete this form will

result in denial of request.

LIVE SCAN FINGERPRINT BACKGROUND CHECK REQUEST

Purpose: To conduct a civil fingerprint-based background check for employment, to volunteer, or for licensing purposes as authorized by law.

Instructions: See page two.

I. Authorizing Information

1. Fingerprint Reason Code 2. Requestor/Agency ID 3. Agency Name 4. Individual ID (MNU-OA)

LL 1479J

MI Dept of Licensing & Regulatory Affairs - Liquor Control

II. Applicant Information:

Type or clearly print answers in all fields before going to be

fingerprinted.

1a. Last Name 1b. First Name 1c. Middle Initial 1d. Suffix

2. Any Alternative Names, Last Names, or Aliases 3. Social Security Number (Optional)

4. Place of Birth (State or Country) 5. Date of Birth 6. Phone Number 7. Driver's License / State ID Number 8. Issuing State

9. Home Address 10. City 11. State 12. ZIP Code

13. Sex 14. Race 15. Height 16. Weight 17. Eye Color 18. Hair Color

III. Live Scan Information

1. Date Printed 2. Picture ID Type Presented 3. Transaction Control Number (TCN) 4. Live Scan Operator*

* When an individual ID is provided, please enter the ID into the Miscellaneous Number (MNU) field on the Live Scan device. Select OA

Originating

Agency Identifier and then enter the unique identifier in the Identification Code field.

IV. Privacy Act Statement

Authority: Acquisition, preservation, and exchange of fingerprints and associated information by the Federal Bureau of Investigation

(FBI) is generally authorized under 28 U.S.C. 534. Depending on the nature of your application, supplemental authorities include

Federal statutes, State statutes pursuant to Pub. L. 92-544, Presidential Executive Orders, and federal regulations. Providing your

fingerprints and associated information is voluntary; however, failure to do so may affect completion or approval of your application.

Principal Purpose: Certain determinations, such as employment, licensing, and security clearances, may be predicated on

fingerprint-based background checks. Your fingerprints and associated information/biometrics may be provided to the employing,

investigating, or otherwise responsible agency, and/or the FBI for the purpose of comparing your fingerprints to other fingerprints in

the FBI's Next Generation Identification (NGI) system or its successor systems (including civil, criminal, and latent fingerprint

repositories) or other available records of the employing, investigating, or otherwise responsible agency. The FBI may retain your

fingerprints and associated information/biometrics in NGI after the completion of this application and, while retained, your fingerprints

may continue to be compared against other fingerprints submitted to or retained by NGI.

Routine Uses: During the processing of this application and for as long thereafter as your fingerprints and associated

information/biometrics are retained in NGI, your information may be disclosed pursuant to your consent, and may be disclosed

without your consent as permitted by the Privacy Act of 1974 and all applicable Routine Uses as may be published at any time in the

Federal Register, including the Routine Uses for the NGI system and the FBI's Blanket Routine Uses. Routine Uses include, but are

not limited to, disclosures to: employing, governmental or authorized non-governmental agencies responsible for employment,

contracting, licensing, security clearances, and other suitability determinations; local, state, tribal, or federal law enforcement

agencies; criminal justice agencies; and agencies responsible for national security or public safety.

V. Procedure to Obtain a Change, Correction, or Update of Identification Records

If, after reviewing his/her identification record, the subject thereof believes that it is incorrect or incomplete in any respect and wishes

changes, corrections, or updating of the alleged deficiency; he/she should make application directly to the agency which contributed

the questioned information. The subject of a record may also direct his/her challenge as to the accuracy or completeness of any

entry on his/her record to the FBI, Criminal Justice Information Services (CJIS) Division, ATTN: SCU, Mod. D2, 1000 Custer Hollow

Road, Clarksburg, WV 26306. The FBI will then forward the challenge to the agency which submitted the data requesting that agency

to verify or correct the challenged entry. Upon the receipt of an official communication directly from the agency which contributed the

original information, the FBI CJIS Division will make any changes necessary in accordance with the information supplied by that

agency. (28 CFR § 16.34)

VI. Consent

I understand that my personal information and biometric data being submitted by Live Scan, will be used to search against

identification records from both the Michigan State Police (MSP) and the FBI for the purpose listed above. I hereby authorize the

release of my personal information for such purposes and release of any records found to the authorized requesting agency listed

above.

Signature: Date:

Credit Card Authorization Form

Michigan Department of Licensing and Regulatory Affairs

Finance and Administrative Services

Revenue Services

Name on Card:

Card Number:

Security Code/CVV Code:

Billing Address:

City: State: Zip Code:

Phone:

Email:

Payment is for:

Applicant/Licensee Name: Request or Business ID #:

Payment Amount:

Check One:

Signature

* * FAX COMPLETED FORM TO SECURE FAX LINE: 517-284-8557 * *

* * DO NOT EMAIL OR MAIL THIS FORM * *

Requests with credit card payments that are not faxed to the above secure fax line will be destroyed along with the credit card authorization in

order to ensure the security of applicants’ personal credit card numbers.

* *IF YOU ARE NOT SUBMITTING AN APPLICATION FORM WITH THIS CREDIT CARD AUTHORIZATION, YOU MUST PROVIDE AN

ITEMIZATION OF THE FEES FOR WHICH YOU ARE SUBMITTING PAYMENT OR YOUR PAYMENT WILL NOT BE PROCESSED* *

LARA is an equal opportunity employer/program. Auxiliary aids, services and other reasonable accommodations are available upon request to individuals with disabilities.

LCC-300 (10-20)

IF YOU ARE NOT SUBMITTING AN APPLICATION FORM WITH THIS

CREDIT CARD AUTHORIZATION, YOU MUST PROVIDE AN

ITEMIZATION OF THE FEES FOR WHICH YOU ARE SUBMITTING

PAYMENT OR YOUR PAYMENT WILL NOT BE PROCESSED.

Credit Card Payment Itemization:

Special License Fee(s):

Sunday Sales Permit (AM):

Sunday Sales Permit (PM):

Catering Permit:

New Add Bar Transfer Add Bar:

License Renewal Fee(s):

New Retailer License(s):

Manufacturer License(s):

Transfer Retailer License(s):

Temporary Authorization Fee:

Inspection Fee(s):

Fee Amount

MLCC

Fee Code

4036

4008

4037

4004

4038

4012

4034

4033

4032

4031

4012/4034

Fee Type

4085

Wholesaler License(s):

LARA Revenue Services is not a part of the Michigan Liquor Control

Commission (MLCC). Receipt of payment and application forms by

LARA Revenue Services does not constitute receipt of an application

by the MLCC. Applications submitted through LARA Revenue

Services may take up to two (2) additional business days to be

received by the MLCC after receipt by LARA Revenue Services.

For requests that require a timely receipt of an application by the

MLCC to be processed, such as Special Licenses and temporary

requests, please ensure that your application will be received in

adequate time to be processed by the MLCC after the payment is

received and processed by LARA Revenue Services.

LARA Revenue Services is not a part of

the Michigan Liquor Control

Commission (see note below).

Conditional License

4012

Expiration Date:

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