Beer And Wine Tasting Permit Application {LCC-255}

For more information on manufacturer and wholesaler licenses and permits, please visit the Liquor Control Commission's frequently asked questions website by clicking this link . Beer and Wine Tasting Permit ApplicationMichigan Department of Licensing and Regulatory Affairs Liquor Control Commission (MLCC) Toll-Free: 866-813-0011 - www.michigan.gov/lcc Requirements 1.A Beer and Wine Tasting Permit approved by the MLCC is required to conduct beer and wine tastings on offpremises licensed establishments that hold a Specially Designated Merchant (SDM) license. You must possess this permit prior to conducting samplings. 2.Licensees eligible to obtain this permit are limited to the following: Outstate Seller of Beer, Outstate Seller of Wine,Wine Maker, Micro Brewer, Brewer, or Specially Designated Merchant (SDM). 3.The Beer and Wine Tasting Event Permit Application must be completed, signed, and returned along with a $70.00inspection fee. 4.An SDM licensee that also holds a license allowing the consumption of alcoholic liquor on the premises at the sameaddress may not obtain a Beer and Wine Tasting Permit. For example, a Class C and SDM licensed business is not eligible. 5.A customer cannot be charged for the tasting of the beer or wine.6.The tasting samples provided to a customer cannot exceed 3 servings at up to 3 ounces of beer or 2 ounces of winewithin a 24-hour period. 7.The MLCC must be notified at least 10 days prior to the beer and wine tasting event regarding the date, time andlocation of the event. Submission of the Event Notification form (LCC-257) is required. 8.The employee or licensed agent of the Outstate Seller of Beer, Outstate Seller of Wine, Wine Maker, Micro Brewer,Brewer, or SDM conducting the beer and wine sampling event must have successfully completed a server training program approved by the MLCC in accordance with the provisions of MCL 436.1906 and shall show verification of successful completion of server training upon request of an MLCC representative or other law enforcement officer. 9.The beer and wine used for the tasting must come from the inventory of the SDM and all open bottles must beremoved from the premises on the same business day or resealed and stored in a locked, separate storage compartment on the licensed premises when not being used for the activities allowed by the Beer and Wine Tasting Permit. 10.All beer and wine tasting events must be conducted during the legal hours for the sale of beer and wine on thelicensed premises of the SDM licensee. American LegalNet, Inc. www.FormsWorkFlow.com Michigan Department of Licensing and Regulatory Affairs Liquor Control Commission (MLCC) Toll-Free: 866-813-0011 - www.michigan.gov/lcc Business ID: Request ID: (For MLCC use only)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.Contact Name:Email:Phone:LARA is an equal opportunity employer/program. Auxiliary aids, services and other reasonable accommodations are available upon request to individuals with disabilities.LCC-255 (02/17)Licensee name(s):Address:City:Zip Code:City/township/village:County: Beer and Wine Tasting Permit ApplicationFor more information on manufacturer and wholesaler licenses and permits, please visit the Liquor Control Commission's frequently asked questions website by clicking this link .Please return this completed form along with inspection fee 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: 517-284-8557Part 3 - Signature of Licensee The licensee must submit the Beer and Wine Tasting Event Notification form (LCC-257) at least ten (10) business days prior to conducting a beer and wine tasting event. 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. Date Signature of Licensee Print Name of Licensee & Title $70.00 Inspection Fee - Make check payable to State of Michigan (MLCC Fee Code 4036)Part 2 - Inspection Fee 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 Authorization Fee: Inspection Fee(s): Fee AmountMLCC Fee Code40364008403740044038401240344033403240314012/4034Fee Type4085 Wholesaler License(s): LARA Revenue Services is not a part of the Michigan Liquor Control Commission (MLCC). Receipt of payment and application forms by LARA Revenue Services does not constitute receipt of an applicationby the MLCC. Applications submitted through LARA Revenue Services may take up to two (2) additional business days to be received by the MLCC after receipt by LARA Revenue Services. For requests that require a timely receipt of an application by the MLCC to be processed, such as Special Licenses and temporary requests, please ensure that your application will be received in adequate time to be processed by the MLCC after the payment is received and processed by LARA Revenue Services. LARA Revenue Services is not a part of the Michigan Liquor Control Commission (see note below). Conditional License 4012 Expiration Date: American LegalNet, Inc. www.FormsWorkFlow.com