For information on retail licenses and permits, please visit the Liquor Control Commission's frequently asked questions website by clicking this link .Michigan Department of Licensing and Regulatory AffairsLiquor Control Commission (MLCC) Toll-Free: 866-813-0011 - www.michigan.gov/lcc Business ID: Request ID:(For MLCC Use Only)Banquet Facility Permit Application(Authorized by MCL 436.1522)Part 1 - Licensee Information Individuals, please state your legal name. Corporations or Limited Liability Companies, please state your name as it is filed with the State of Michigan Corporation Division.Licensee name(s):Address:City:Zip Code:Address of proposed banquet facility: City/township/village where banquet facility will be located:1.You must obtain approval for the proposed banquet facility from the legislative body of the local governmental unit where thefacility will be located. See Local Government Approval Form (Form LCC-106) 2.The proposed banquet facility shall be used only for scheduled functions and events, shall not have regular meal service, and shallnot be generally open to the public. 3.You must provide documentary proof that you have a preexisting ownership or lease interest in the proposed banquet facility, suchas a deed, land contract, lease, or other executed documentation to demonstrate you have authority to operate the proposed banquet facility at the proposed location. 4.You must demonstrate to the Commission that at least 50% of the gross receipts for your existing on-premises license are derivedfrom the sale of food and nonalcoholic beverages prepared for consumption at your existing licensed premises. Part 3 - Inspection and Permit Fees - Make checks payable to State of Michigan Inspection Fee and Permit Fees - Pursuant to MCL 436.1529(4) a nonrefundable inspection fee of $70.00 shall be paid to the Commission by a licensee at the time of filing of a request for a new license or permit. Requests for a new permit in conjunction with a request for a new license or transfer of an existing license do not require an additional inspection fee. Pursuant to MCL 436.1525(1), permit fees shall be paid to the Commission for a request for a new permit.Part 2 - Permits, and Permissions (To Be Held In Conjunction with Banquet Facility Permit) Sunday Sales Permit (AM)* $160.00 Banquet Facility Permit$600.00 Sunday Sales Permit (PM)** $90.00 Outdoor Service Entertainment Permit Dance Permit Topless Activity Permit Specific Purpose Permit: Extended Hours Permit: Dance Entertainment Days/Hours: Days/Hours: Activity requested:No chargeNo chargeNo chargeNo chargeNo chargeNo charge*Sunday Sales Permit (AM) allows the sale of liquor, beer, and wine on Sunday mornings between 7:00am and 12:00 noon, if allowed by the local unit of government. (For banquet facilities held in conjunction with A-Hotel, B-Hotel, Tavern, or Class C licenses) **Sunday Sales Permit (PM) allows the sale of liquor on Sunday afternoons and evenings between 12:00 noon and 2:00am (Monday morning), if allowed by the local unit of government. No Sunday Sales Permit (PM) is required for the sale of beer and wine on Sunday after 12:00 noon. (For banquet facilities held in conjunction with B-Hotel or Class C licenses ONLY.)Inspection Fee:Permit Fee(s):TOTAL FEES:Page 1 of 2LARA is an equal opportunity employer/program. Auxiliary aids, services and other reasonable accommodations are available upon request to individuals with disabilities. Check if this request is part of a request for a new licence or transfer of an existing license. Fee Code MLCC Use OnlyTransferNew Base Fee:Permits & Permissions Base Fee:Permits & PermissionsLeave Blank - MLCC Use Only LCC-200 (02-18) American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2LARA is an equal opportunity employer/program. Auxiliary aids, services and other reasonable accommodations are available upon request to individuals with disabilities. Part 4 - Contact InformationPart 5 - Attorney Information (If You Have An Attorney Representing You For This Application)Provide information on the contact person for this application. Please note that corporations and limited liability companies must provide documentation (e.g. meeting minutes, corporate resolution) authorizing anyone other than the applicant or an attorney of record to be the contact person. If an authorization is not provided, your contact person will not be acknowledged if they are anyone other than the applicant or attorney.Contact name:Mailing address:Fax number:Phone:Email:Relationship:What is your preferred method of contact?What is your preferred method for receiving a Commission Order? Phone Mail Fax Email Member Number: P-Attorney name:Attorney address:Fax number:Phone:Email: Would you prefer that we contact your attorney for all licensing matters related to this application?Would you prefer any notices or closing packages be sent directly to your attorney? Mail Email Fax No Yes Yes NoPart 6 - Signature of Licensee Be advised that the information contained in this application will only be used for this request. This section will need to be completed for each subsequent request you make with this office. Notice: Under administrative rule R 436.1003, the licensee shall comply with all state and local building, plumbing, zoning, sanitation, and health laws, rules, and ordinances as determined by the state and local law enforcements officials who have jurisdiction over the licensee. Approval of this application by the Michigan Liquor Control Commission does not waive any of these requirements. The licensee must obtain all other required state and local licenses, permits, and approvals for this business before using this license for the sale of alcoholic liquor on the licensed premises. 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. The person signing this form has demonstrated that they have authorization to do so and have attached appropriate documentation as proof. Date Signature of Licensee Print Name of Licensee & TitlePlease return this completed form along with corresponding documents and fees to: Michigan Liquor Control Commission Mailing address: P.O. Box 30005, Lansing, MI 48909 Hand deliveries or overnight packages: Constitution Hall - 525 W. Allegan, Lansing, MI 48933 Fax to: 517-284-8557LCC-200 (02-18) American LegalNet, Inc. www.FormsWorkFlow.com Credit Card Authorization FormMichigan Department of Licensing and Regulatory Affairs Finance and Administrative Services Revenue Services Name: Card Number: Security Code/CVV Code: Address: City: State: Zip Code: Phone: Payment is for: Applicant/Licensee Name: Request or Business ID #: Transaction Amount: Discover MasterCard VisaCheck One: Signature * * FAX COMPLETED FORM TO SECURE FAX LINE: 517-284-8557 * * * * DO NOT EMAIL OR MAIL THIS FORM * * Requests with credit card payments that are not faxed to the above secure fax line will be destroyed along with the credit card authorization in order to ensure the security of applicants222 personal credit card numbers. * *IF YOU ARE NOT SUBMITTING AN APPLICATION FORM WITH THIS CREDIT CARD AUTHORIZATION, YOU MUST PROVIDE AN ITEMIZATION OF THE FEES FOR WHICH YOU ARE SUBMITTING PAYMENT OR YOUR PAYMENT WILL NOT BE PROCESSED* *LARA is an equal opportunity employer/program. Auxiliary aids, services and other reasonable accommodations are available upon request to individuals with disabilities. LCC-300 (02-18)IF YOU ARE NOT SUBMITTING AN APPLICATION FORM WITH THIS CREDIT CARD AUTHORIZATION, YOU MUST PROVIDE AN ITEMIZATION OF THE FEES FOR WHICH YOU ARE SUBMITTING PAYMENT OR YOUR PAYMENT WILL NOT BE PROCESSED. Credit Card Payment Itemization: Special License Fee(s): Sunday Sales Permit (AM): Sunday Sales Permit (PM): Catering Permit: New Add Bar Transfer Add Bar: License Renewal Fee(s): New Retailer License(s): Manufacturer License(s): Transfer Retailer License(s): Temporary Auth