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 Business ID: Request ID: (For MLCC use only) APPLICANT QUESTIONNAIRE - New On-premises Banquet Facility Permit (Authorized by MCL 436.1522) INSTRUCTIONS: To apply for a new On-premises Banquet Facility Permit complete and return this questionnaire with a $70 inspection fee to the address printed above. _________________________________________________________________________________________ Name of Licensee(s) (Individual, partnership, corporation, limited liability company) _________________________________________________________________________________________ Current Business Address (Street, City, Township, County, Zip Code) Type of License and Number: _________________________________________________________________ Total Gross Receipts of Business:______________________________________________________________ Year Amount Year Amount Total Gross Receipts of Food and Non-alcoholic Beverages: ____________________________________________________________________ Year Amount Year Amount * Please be advised the statute prescribes that you must demonstrate that at least 50% of the gross receipts of your current business is from the sale of food and non-alcoholic beverages prepared for consumption on the premises. _________________________________________________________________________________________ Proposed Address of Banquet Facility (Street, City, Township, County, Zip Code) Do you or Will you have control of this facility? YES NO Property document & diagram attached? YES NO WILL BE AVAILABLE *Please be advised that you must provide a diagram and documentation that demonstrates a preexisting ownership or lease interest in the banquet facility prior to issuance of the permit. Permits Requested for Banquet Facility: ___Dance ___Entertainment ___Outdoor Service ___Sunday Sales ___Topless Activity ____Direct Connection ____Food ____Golf ____ Miscellaneous ________________ List types of scheduled events and functions that will be held at this facility: List the hours of operation at this facility: ________________________________________________________ *Please be advised that a banquet facility shall not have regular meal service and shall not be generally open to the public. _________________________________________________________________________________________ Title Print name of contact person _________________________________________________________________________________________ Telephone Number Mailing address if different from above _________________________________________________________________________________________ Date Signature LC-618BF Rev. 06/14 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. www.FormsWorkFlow.com