Michigan Breweries Monthly Report Of Sales
Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Michigan Breweries Monthly Report Of Sales Form. This is a Michigan form and can be use in Liquor Control Commission Statewide.
Tags: Michigan Breweries Monthly Report Of Sales, LC 859, Michigan Statewide, Liquor Control Commission
Michigan Department of Licensing and Regulatory Affairs
MICHIGAN LIQUOR CONTROL COMMISSION (MLCC)
7150 Harris Drive, P.O. Box 30005 - Lansing, Michigan 48909-7505
MICHIGAN BREWERIES MONTHLY REPORT OF SALES
Name & Address
Month – Year
Cases – enter additional sizes & quantities
Sales to Michigan
Sales to Michigan Retailers
Sales to Michigan Consumers
Subtotal Michigan Sales
Sales to Other States
Note: Computer reports which show this information in the same sequence may be submitted in lieu of this report. Contact (517) 322-6380 for more
information. I DECLARE THAT THIS REPORT IS CORRECT (attach a copy to the Michigan Beer Tax Report, LC-803 and mail to the above address.)
Signature of Authorized Official ___________________________________ Title _____________________________ Date _______________
LC-3859 (Rev. 07/11)
AUTHORITY: MCL 436.1409; R 436.1621
PENALTY: Fine &/or License Revocation
LARA is an equal opportunity employer/program.
Auxiliary aids, services and other reasonable accommodations are available upon request to
individuals with disabilities.
American LegalNet, Inc.