Michigan > Statewide > Liquor Control Commission > General Licensing

Request For Waiver Of Statute Or Licensing Qualifications LC 1865 - Michigan

Request For Waiver Of Statute Or Licensing Qualifications Form. This is a Michigan form and can be used in General Licensing Liquor Control Commission Statewide .
 Fillable pdf Last Modified 7/29/2011
Get this form for FREE as a print-only pdf

Print Form Request ID# ______________ Michigan Department of Licensing and Regulatory Affairs LIQUOR CONTROL COMMISSION 7150 Harris Drive, P.O. Box 30005 - Lansing, Michigan 48909-7505 REQUEST FOR WAIVER OF STATUTE OR LICENSING QUALIFICATIONS Instructions: Complete this form to request a waiver of statute or licensing qualifications. Be specific in the provisions you are asking the Commission to waive. Applicant or Licensee Names: Address of Location to be Licensed or Licensed Address: Types of Licenses requested: Enter Statute or Rule number you are requesting to be waived: Enter the Statute or Rule number which allows the Commission to consider a waiver for this request: The undersigned applicant or licensee requests a waiver for the following reasons: Date Signed: Applicant/Licensee Signature: Applicant/Licensee Signature: Applicant/Licensee Signature: Applicant/Licensee Signature: LC-1865 (Rev. 04/11) AUTHORITY: PA 58 of 1998 COMPLETION: Mandatory PENALTY: No waiver granted 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
Link/Embed this Document
URL
Embed


Popular Searches

  1. notice of appeal
  2. Guardianship
  3. notice
  4. child custody
  5. divorce
  6. complaint
  7. JUDGMENT
  8. certificate of service
  9. default judgment
  10. answer

Bookmark and Share