Free Michigan Lcc 3010 Template in PDF
The Michigan LCC 3010 form serves as a crucial document for businesses involved in the liquor industry within the state. It is designed to report essential information about stockholders, members, and partners of a business entity. This form is a requirement for corporations, limited liability companies (LLCs), and limited partnerships, ensuring that the Michigan Liquor Control Commission (MLCC) has accurate records of ownership and management. Key sections of the form include details about the entity's name, registered address, and the identities of all stockholders or members. Additionally, it requires information on corporate officers, directors, and managers, along with their respective shares and dates of issuance. The form emphasizes the importance of truthfulness, as the applicant must certify the accuracy of the information provided. Understanding the requirements and implications of the LCC 3010 form is essential for compliance with Michigan's liquor laws, helping businesses navigate the regulatory landscape effectively.
Form 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)
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: |
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Certificate Numbers: Shares Issued: Date Issued/Acquired: |
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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: |
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Percent % Issued: Date Issued/Acquired: |
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Name and address of Managers and Assignees, pursuant to administrative rule R 436.1110:
LARA is an equal opportunity employer/program. Auxiliary aids, services and other reasonable accommodations are available upon request to individuals with disabilities. |
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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)
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: |
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Percent % Issued: Date Issued/Acquired: |
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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 |
LARA is an equal opportunity employer/program. Auxiliary aids, services and other reasonable accommodations are available upon request to individuals with disabilities. |
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Document Specs
| Fact Name | Details |
|---|---|
| Purpose of the Form | The LCC 3010 form is used to report stockholders, members, or partners of a business entity applying for a liquor license in Michigan. |
| Governing Laws | This form is authorized under Michigan Compiled Laws (MCL) 436.1529(1) and administrative rules R 436.1051 and R 436.1110. |
| Entity Types | The form accommodates various business structures, including corporations, limited liability companies (LLCs), and limited partnerships. |
| Information Required | Applicants must provide detailed information about stockholders, members, or partners, including names, addresses, and the percentage of ownership. |
| Certification | The form requires a signature from the applicant, certifying that the provided information is accurate and complies with the Michigan Liquor Control Code. |
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