Print Form Michigan Department of Licensing and Regulatory Affairs MICHIGAN LIQUOR CONTROL COMMISSION (MLCC) 7150 Harris Drive, P.O. Box 30005, Lansing, MI 48909-7505 TO: ALL MICHIGAN LIQUOR CONTROL LICENSED CORPORATIONS, LIMITED LIABILITY COMPANIES AND LIMITED PARTNERSHIPS Enclosed with these document(s) you will find a statement as to Stock Issuance / Membership Interest or Change of Interest in a Limited Partnership, LC-50-2. This statement is due by July 1, each licensing year as required by Section 529(2) of the Michigan Liquor Control Code PA 58 of 1998, being MCL 436.1529(2). You may choose to copy this form, prior to executing it, for future use. We do not supply these statements yearly; however, this form can be downloaded from the forms page of the Michigan Liquor Control Commission website at www.michigan.gov/lcc. American LegalNet, Inc. www.FormsWorkFlow.com Michigan Department of Licensing and Regulatory Affairs MICHIGAN LIQUOR CONTROL COMMISSION (MLCC) 7150 Harris Drive, P.O. Box 30005, Lansing, MI 48909-7505 INFORMATION AS TO STOCK ISSUANCE / MEMBERSHIP INTEREST OR CHANGE OF INTEREST IN A LIMITED PARTNERSHIP We request that you complete this form as to stock issuance, membership interest or change in the interest in the Limited Partnership and return it to the address above by July1. Each licensed Private Corporation, Limited Liability Company (LLC), Limited Partnership is required to file this form by July 1st each year pursuant to Section 529(2) being MCL 436.1529(2), of the Michigan Compiled Laws. Please complete and return this form whether or not you have transferred any stock, membership interest, or interest in the Limited Partnership, in the past licensing year. I, ____________________________________ of ________________________________________ Name of Corporation, LLC, or Limited Partnership holder of _____________________________ located at __________________________________ , Address Type of License do hereby state that the following information is correct: (check the appropriate licensed entity and fill in the blank even if it is zero) This Corporation has transferred, issued and/or redeemed _______ shares of stock between May 1, 20___ and April 30, 20___. This Limited Liability Company has transferred, assigned and/or reorganized _______ percentage of the membership interests. This Limited Partnership has transferred, assigned and/or reorganized _______ percentage of the Limited Partnership interests. Please list the names of all persons who have acquired any shares of stock, membership interest, or interest in a Limited Partnership, who have not yet been reported in writing to the Commission (attach additional sheets if necessary). Signature_________________________________ Print Name ________________________________ Name of Corporation or Limited Partnership _______________________________________________ LC-50-2 Rev. 04/11 AUTHORITY: MCL 436.1529(2) COMPLETION: Mandatory 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