Michigan Department of Licensing and Regulatory Affairs MICHIGAN LIQUOR CONTROL COMMISSION (MLCC) Constitution Hall – 525 W. Allegan, Lansing, MI 48933 Mailing Address: PO Box 30005, Lansing, Michigan 48909 Toll Free (866) 813-0011 – www.michigan.gov/lcc REPORT OF VEHICLES USED FOR DELIVERY OF BEER OR WINE (Authorized by MCL 436.1525 and MAC R 436.1859) _________________________________________________________________________________________________ GENERAL INSTRUCTIONS • • • • This form is required from all WHOLESALERS that deliver beer and/or wine to retail licensees. Include this report with the Contract for License or the Application for Renewal. MAKE A COPY OF THIS REPORT FOR YOUR FILE. Enter the information requested for each vehicle. This information is used to determine license fees. The Wholesale license fee is $300.00 for the first vehicle and $50.00 for each additional vehicle. Each vehicle added, replaced, or terminated during the licensing year (May 1 through April 30) must be reported using the Amended Report of Vehicles Used for Delivery of Beer or Wine (LC-MW-136A). There is a fee of $50.00 for each additional vehicle which increases the total number of licensed vehicles. There is not license fee for replaced vehicles. There is no refund of any license fees for terminated vehicles. Decals will be issued for each vehicle to show that the license fee has been paid. Licensee Name: Street Address: City: State: Type of License: License Number: Contact Name: Year of Vehicle Zip Code: Phone Number: Make of Vehicle Email: Vehicle Identification Number (VIN) MLCC Use Only Decal No. Assigned 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Signature: LC-MW-136A (Rev. 09/15) Authority: MCL 436.1525 and MAC R 436.1859 Completion: Mandatory Penalty: No License Date: 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