Michigan Lcc 3010 Form PDF Details

In the regulatory landscape of Michigan's alcohol industry, one document plays a pivotal role in maintaining transparency and accountability among businesses involved in the sale and distribution of liquor: the Michigan LCC 3010 form. Issued by the Michigan Department of Licensing and Regulatory Affairs Liquor Control Commission (MLCC), this form serves as a comprehensive report of stockholders, members, and partners related to entities dealing with liquor licenses. Its purpose is twofold: to uphold the stipulations authorized by Michigan Compiled Laws (MCL 436.1529(1)) and to align with the administrative rules R 436.1051 and R 436.1110, ensuring that all shareholders or stakeholders of corporations, limited liability companies, and limited partnerships are declared accurately. Entities are required to disclose detailed information including names and addresses of all stockholders or members, the percentage of shares issued, acquisition dates, and the particulars of corporate officers, managers, or assignees, all of which must be verified for accuracy by the applicant's signature. This form stands as a testament to the holder's agreement to comply with the robust framework of the Michigan Liquor Control Code and its administrative rules, while also serving as a reminder of the serious implications tied to the submission of false or fraudulent information under MCL 436.2003.

QuestionAnswer
Form NameMichigan Lcc 3010 Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other names2003, licensee, form lcc 3010, LARA

Form Preview Example

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

Report of Stockholders/Members/Partners

(Authorized by MCL 436.1529(1); R 436.1051 and R 436.1110)

Business ID:

Request ID:

(For MLCC use only)

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:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name and address of Corporate Officers and Directors, pursuant to administrative rule R 436.1109:

Limited Liability Companies - Please complete this section and attach more copies of this page if more room is needed.

Name and address of all members:

 

Percent % Issued: Date Issued/Acquired:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name and address of Managers and Assignees, pursuant to administrative rule R 436.1110:

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

 

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

Report of Stockholders/Members/Partners

(Authorized by MCL 436.1529(1); R 436.1051 and R 436.1110)

Business ID:

Request ID:

(For MLCC use only)

Limited Partnerships - Please complete this section and attach more copies of this page if more room is needed.

Name and address of all partners:

 

Percent % Issued: Date Issued/Acquired:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name and address of Managers, pursuant to administrative rule R 436.1111:

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 436.2003.

Date

Print name of applicant/licensee and title

Signature of applicant/licensee

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 2 of 2

 

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