Michigan > Statewide > Liquor Control Commission > General Licensing
Release Of Alcohol Or Alcoholic Beverages For Commercial Use LC MW 836 - Michigan
| Release Of Alcohol Or Alcoholic Beverages For Commercial Use Form. This is a Michigan form and can be used in General Licensing Liquor Control Commission Statewide . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
Michigan Department of Labor & Economic Growth LIQUOR CONTROL COMMISSION 7150 Harris Drive, P.O. Box 30005 Lansing, Michigan 48909-7505 RELEASE NO. __________________ RELEASE OF ALCOHOL OR ALCOHOLIC BEVERAGES FOR COMMERCIAL USE Instructions: · Michigan businesses which use alcoholic beverages for commercial purposes are required to complete and submit this form for each purchase of alcohol or alcoholic beverages. Failure to obtain the written Certificate of Release by the Commission is a violation of the Liquor Control Act. · · · Mail all four copies to the Liquor Control Commission, Manufactures & Wholesalers Section, P.O. Box 30005, Lansing, Michigan, 48909. After issuing the Certificate of Release, the Michigan Liquor Control Commission will return the CANARY copy of this form to the BUYER, and the GOLD and PINK copies to the Seller of Alcohol. Sellers of Alcohol may not ship alcohol or alcoholic beverages to the BUYER until they receive the GOLD and PINK copies of the approved Certificate of Release. The PINK copy is to be sent with the shipment. 1. Name and Address of Buyer 2. Name and Address of Seller Buyer's Michigan License or Permit No. Seller's Michigan License No. 3. Describe type and use of alcohol (Check the appropriate box or fill in the blank) A. Check type of Alcohol Used: Ethyl Alcohol Distilled Spirits / Blending Whiskeys Wine Other (describe): B. Check Commercial Use: Medicines / Drugs / Pharmaceuticals Scientific Blending or Rectifying Alcoholic Beverages Chemicals Flavoring Extracts Other (describe): 4. Describe Alcohol or Alcoholic Beverages Date to be shipped Quantity (size, pack, case, etc.) Wine Gallons Proof Gallons 5. MOTOR OR RAIL CARRIER USED FOR SHIPMENT 6. SIGNATURE OF BUYER DATE CERTIFICATE OF RELEASE Approval is granted for the release of the alcoholic beverages described in #4 above. ATTENTION BUYER: Retain the CANARY COPY as proof of Release ______________________________ Manufacturers & Wholesalers Section __________ Date ATTENTION SELLER: Retain the GOLD COPY as proof of Release Forward PINK COPY with shipment of alcohol or alcoholic beverages. LC-MW 836 (Rev. 02/05) AUTHORITY: MCL R 436.1809(5) COMPLETION: Mandatory PENALTY: License Revocation The Department of Labor & Economic Growth will not discriminate against any individual or group because of race, sex, religion, age, national origin, color, marital status, political beliefs or disability. If you need help with reading, writing, hearing, etc., under the Americans with Disabilities Act, you may make your needs known to this agency. American LegalNet, Inc. www.FormsWorkflow.com
|
|||||||
