Michigan Department of Labor & Economic Growth MICHIGAN LIQUOR CONTROL COMMISSION (MLCC) 7150 Harris Drive, P.O. Box 30005 Lansing, Michigan 48909-7505 AMENDED REPORT OF VEHICLES USED FOR DELIVERY OF BEER OR WINE _________________________________________________________________________________________________ GENERAL INSTRUCTIONS Wholesalers are required to file this form when they add, delete, or replace previously licensed vehicles. Failure to complete this form and pay any required license fees is a violation of the Liquor Control Code. It is the responsibility of the Wholesaler to remove and destroy the decal of any vehicle listed in Section C before it leaves the Wholesaler’s possession. If any vehicles are listed in Section C, the Wholesaler must sign and date the certification and sign this form at the bottom. New decals will be issued for vehicles listed in Section A and Section B. Licensee Name: Street Address: City: State: Type of License: License Number: Section A Added Vehicles Year of Vehicle Zip Code: *There is a $50.00 license fee for each added vehicle. Make checks payable to the State of Michigan. Make of Vehicle Vehicle Identification No. MLCC Use Only Decal No. Assigned Section B New Replacements *If there is no charge in the number of licensed vehicles, no additional license fee is necessary. Section C must be completed to list the vehicles that replace the vehicles listed in this section. Year of Vehicle Make of Vehicle Vehicle Identification No. MLCC Use Only Decal No. Assigned Section C Replaced Vehicles *If there is no change in number of licensed vehicles, no additional license fee is necessary. Section B must be completed to list the vehicles that replaced the vehicles listed in this section. Year of Vehicle Make of Vehicle Vehicle Identification No. MLCC Use Only Decal No. Assigned I certify that I have destroyed the decal for any vehicle listed in Section C. Signature: Title: Signature: Date: Date: Cashier Validation (Do not write in this space.) LC-MW-136A (Rev. 10/07) Authority: MCL 436.1525 Completion: Mandatory Penalty: No License The Department of Labor & Economic Growth will not discriminate against any individual or group because of race, sex, religion, age, national origin, color, marital status, disability, or political beliefs. If you need help with reading, writing, hearing, etc., under the Americans with Disabilities Act, you may make your needs known to this agency. American LegalNet, Inc. www.FormsWorkflow.com