Michigan Department of Licensing and Regulatory Affairs Liquor Control Commission (MLCC)

Michigan Department of Licensing and Regulatory Affairs
Liquor Control Commission (MLCC)
Constitution Hall - 525 W. Allegan, Lansing, MI 48933
Mailing address: P.O. Box 30005, Lansing, MI 48909
Toll-Free: 866-813-0011 - www.michigan.gov/lcc
OUTSTATE SELLER MONTHLY REPORT (LCC-3023)
Check only one
Beer
Mixed Spirit Drink
Wine
Business Name:
License Number:
Address:
City, State & Zip Code:
Phone:
Fax number:
Month & Year
Reported:
Email:
INSTRUCTIONS:
Who must file:
Outstate sellers that sell beer, wine, or mixed spirit drink to Michigan Wholesale licensees.
1. Enter heading information requested above.
2. Submit a separate report for Beer, Wine, or Mixed Spirit Drink and attach the appropriate invoices to each report submitted.
3. Outstate Sellers must attach copies of all invoices for BEER, WINE, OR MIXED SPIRIT DRINK sold to a Michigan Wholesale licensee.
4. This report must be filed on or before the 15th day of each month for all sales for the preceding month.
THIS REPORT MUST BE FILED EVEN IF NO TRANSACTIONS HAVE OCCURRED
PLEASE COMPLETE THE FOLLOWING INFORMATION:
Total number of invoices being submitted
Check here if no sales transactions this month
WARNING: Licensees that fail to submit a required report or that file a false report may have
their license suspended or revoked.
I certify that the information contained in this form is true and accurate to the best of my knowledge and belief. I also understand that providing false or fraudulent
information is a violation of the Liquor Control Code pursuant to MCL 436.2003.
Print Name of Licensee & Title
LCC-3023 (02-16)
Signature of Licensee
Date
LARA is an equal opportunity employer/program. Auxiliary aids, services and other reasonable accommodations are available upon request to individuals with disabilities.