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Application For New Licenses Or Application Of Buyers For Transfer Of Ownership Or Interest In License Form. This is a Michigan form and can be use in Liquor Control Commission Statewide.
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Tags: Application For New Licenses Or Application Of Buyers For Transfer Of Ownership Or Interest In License, LC 687, Michigan Statewide, Liquor Control Commission
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Michigan Department of Licensing and Regulatory Affairs
FOR MLCC USE ONLY
LIQUOR CONTROL COMMISSION (MLCC)
7150 Harris Drive, P.O. Box 30005 - Lansing, Michigan 48909-7505
APPLICATION FOR NEW LICENSES, OR APPLICATION OF BUYERS FOR TRANSFER OF
OWNERSHIP OR INTEREST IN LICENSE
Instructions:
This application must be completed and returned with a $70.00 inspection fee for each license before it
can be considered. All answers must be typed or printed. Sign the completed form in ink and return it to
the Commission with the inspection fee. MAKE ALL CHECKS OR MONEY ORDERS PAYABLE TO
"STATE OF MICHIGAN".
1. Applicant Identification - all applicants
Name of individual, partnership, corporation or limited liability
company who will hold the license:
Contact Person Name:
Business Street Address:
Street Address:
City / State / Zip Code:
City / State / Zip Code:
Township:
County:
Business Phone No.
New License
Transfer of Ownership - NAME of current Licensee:
New Permit
Home Phone No.
Transfer Location From ADDRESS:
TOWNSHIP and COUNTY:
Add Partner
Drop Partner
Add Space
Stock Transfer
Transfer Status from Individual or
Limited Partnership to a Corporation
Transfer Classification
Tavern to Class C
Class C to Tavern
Drop Space
B-Hotel to Class C
Other :
Class C to B-Hotel
3. Retail Applicants - (All existing permits will be included with a transferred license unless cancelled in writing)
3b. Check Type of Permits
3a. Check Type of License
Sunday Sales
Before or After Hours For:
SDM
SDD
Resort Class C
Add Bar
Class C
Dance
Resort A-Hotel
A-Hotel
( Food, Bowling, Golf, Ski, Misc.)
Dance/Entertainment
Resort B-Hotel
B-Hotel
Topless Activity
Outdoor Service
Resort Tavern
Direct Connection
Tavern
Resort G-1
Club
Living Quarters
Resort G-2
G-1
Other:
G-2
4. New Manufacturer or Wholesale Applicants (Check one)
Wholesaler
Wine Maker
Small Wine Maker
Wine Maker Wine Tasting Room
Micro Brewer
Brewer
Manufacturer of Spirits
Industrial Manufacturer
Warehouse
Brewpub
Manufacturer of Mixed Spirit Drinks
Outstate Seller of Mixed Spirit Drinks
Outstate Seller of Wine
Outstate Seller of Beer
Other:
5. Names of Current Licensees:
6. Current Licensed Address:
7. Proposed Licensed Address:
8. Briefly describe this business, for instance - Drug Store, Restaurant, Party Store, Wholesaler, Wine Maker, Etc.
LC 687 Rev. 04/11
American LegalNet, Inc.
www.FormsWorkFlow.com
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9. This proposed licensed business will be owned by: (check one)
Me as the individual owner
The named corporation
The named Liability company
The following partners (indicate limited partners with an "L" before their name)
Partnership Information: (attach additional sheet if necessary)
Name of Partners
Home Address
Phone Number
* All general partners must complete & submit an LC 621, "Individual, General Partner, Stockholder or Member Questionnaire."
All limited partners must complete & submit an LC 38, "Limited Partner, Stockholder or Member Statement."
10. Personal Information - Individual Applicants and Partnership Members Only
Sex
Height
Weight
Hair Color
Date of Birth
Place of Birth
Eye Color
Social Security No.
If you are not a US Citizen - Are you a registered alien?
Yes
No Or, Do you have a Visa?
Yes
No
Full name of spouse:
Have you ever legally changed your name?
Yes
No
If Yes, FROM
TO
No List names:
Have you been known by other names?
Yes
Have you ever been arrested?
No If Yes, list all arrests, excluding minor traffic offenses (include alcohol arrests):
DATE
Yes
PLACE
List your former occupations for the past 3 years:
From-To DATES
OCCUPATION
mm-dd-yyyy format
CHARGE
DISPOSITION
* attach additional sheet if necessary
EMPLOYER NAME AND ADDRESS
to
to
to
I or my spouse previously held or now hold interest in the following licenses for sale of alcoholic beverages as sole licensee,
partner or corporation:
NAME OF LICENSEE
TYPE OF LICENSE
LOCATION
DATE
Do you or your spouse hold any law enforcement powers including powers of arrest?
Yes
No
11. Limited Partnerships-is the limited partnership authorized to do business under the laws of Michigan?
Yes
No
Date authorized:
12. Corporate & Limited Liability Company Applicants Only - stockholders/members must complete a separate survey
Note: Attach copy of filed/proposed Articles of Incorporation, last annual report/statement filed & attach copy of stock options.
Corporate/LLC Name:
Incorporated/Organized in what State?
Alabama
Person(s) authorized to sign the application and any documents required by the MLCC:
American LegalNet, Inc.
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(Check one of each)
Profit or
Non-profit Corporation
Public or
Private Corporation
Date last annual report / statement filed with Michigan Corporation & Securities:
Corporate Officers:
NAME
ADDRESS
PHONE NUMBER
President
Vice-President
Secretary
Treasurer
13. Corporations and Limited Liability Companies - List all persons, companies and other entities who hold or will hold
stock interest or membership interest in applicant entity.
NAME
ADDRESS
PHONE #
% INTEREST
1.
2.
3.
4.
5.
*Note: All persons, companies and other entities holding 10% interest or more must complete and submit an "Individual,
General Partner, Stockholder or Member Questionnaire" (LC-621). All persons, companies and other entities holding less
than 10% interest, must complete and submit a "Limited Partners, Stockholders or Members Statement" (LC-38).
14. Financial Details - All Applicants
(A) Source of funds used to establish business, or which will be used to purchase this business, list name address and
amount of all money lenders. Money lenders to fill out special "Statement of Money Lender" form enclosed.
Address
Name
Amount
$
$
$
(B) Attorney or representative
Address
Phone Number
Name
Address
Phone Number
Name
Address
Phone Number
Address
Phone Number
Address
Phone Number
Name
(C) Real estate is owned by
(D) Realtor/Broker
Name
(E) Accountant or Bookkeeper
Name
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American LegalNet, Inc.
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15. Transaction Details - All Applicants
Note iAny balance owed on the business selling price must be secured by a non-title retaining instrument such as a promissory note,
security agreement, etc.
iLand contracts are not acceptable as security for any unpaid balance to be owed on the business portion of the sale.
iBusiness, fixtures and equipment cannot be listed on land contracts or real estate mortgages.
iAll alcoholic beverage inventory must be paid for in cash at the time of transfer and not by installment payments.
iAcceptable lease agreements must be provided if ownership of real estate is not in the names of applicants.
iPurchasers of "ON-PREMISES" licensed establishments are required to have 10% of the purchase price for the licensed
business, excluding real estate, in their own funds.
Business/Fixtures/Equipment
$
Land
$
Goodwill (if applicable)
$
Building(s)
$
Covenant not to compete
(if applicable)
$
Other
$
Alcoholic beverages (estimate)
$
TOTAL REAL ESTATE COSTS
$
Other inventory (estimate)
$
Down Payment
$
TOTAL COST OF BUSINESS
$
BALANCE OWED
$
Down Payment
$
Secured by
$
BALANCE OWED
$
For balance owed - explain:
For balance owed - explain:
hTerms:
iTerms:
iCollateral:
iCollateral:
The Commission wishes to warn all applicants for licenses not to invest any money or to commit themselves by any binding
agreements in the expectation of being issued a license for sale of alcoholic beverages until officially notified by the
Commission that their application has been approved.
WARNING! Section 436.2003 of the Liquor Code provides:
"A person who makes a false or fraudulent statement to the commission, orally or in writing, for the purpose of inducing the commission
to act or refrain from taking action, or for the purpose of enabling or assisting a person to evade the provisions of this act is guilty of a
violation of this act and is punishable in the manner provided for in section 909. Further, the rules and regulations of the Commission
entitled "General Rules" provide: "A licensee shall not obtain a license for the use or benefit of another person whose name does not
appear on the license nor shall a licensee allow a person whose name does not appear on the license to use or benefit from the
license," and, "A licensee shall not sell or transfer an interest in a business licensed by the Commission without the prior written
approval of the Commission."
I hereby authorize investigators of the Michigan Liquor Control Commission to obtain all documents, accounts, books, records and tax
returns pertaining to myself and this business. I hereby swear that I have read all of the above answers and that they are true and
further that I have read and understand the warning.
Application Date
(MM/DD/YYYY)
LC-687 (Rev. 04/11)
AUTHORITY: MAC R436.1103
COMPLETION: Mandatory
PENALTY: No license granted
____________________________________
Signature of Applicant
Name of person completing this form if not the applicant
(if applicant is a corporation, include title of signor)
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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American LegalNet, Inc.
www.FormsWorkFlow.com