Form MJ18-1203 "License Representative Authorization" - Oregon

What Is Form MJ18-1203?

This is a legal form that was released by the Oregon Liquor Control Commission - a government authority operating within Oregon. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 15, 2019;
  • The latest edition provided by the Oregon Liquor Control Commission;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form MJ18-1203 by clicking the link below or browse more documents and templates provided by the Oregon Liquor Control Commission.

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Download Form MJ18-1203 "License Representative Authorization" - Oregon

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OREGON LIQUOR CONTROL COMMISSION
Supplemental Form:
License Representative Authorization
What is this form?
An applicant or licensee may give a representative authorization to make changes to the license or application on behalf
of the licensee or to receive information about a license or application. The applicant or licensee may use this form to
document that authorization.
Note: This form must be signed by someone who is a licensee or an applicant for the license. If this form is sent to OLCC
via email, it must come from an email address that is already associated with the license or application.
Section 1 – Applicant/Licensee Information
Application/License ID:
Applicant/Licensee Name:
Section 2 – Representative Information
Representative Name:
Representative Phone:
Representative Email:
Section 3 – Authorization
I give permission for the above-named representative to:
Make changes regarding this license/application on my behalf.
Receive information about the status of the license/application, including information about
pending compliance action or communications between OLCC and the licensee/applicant.
This authorization will remain in effect until I rescind my permission in writing and provide a copy to
the Commission.
Comments:
Signature:
Date:
Name:
Title:
[FORM MJ 18-1203] mj_opt_all_auth (revised 20190415) Page 1 of 1
OREGON LIQUOR CONTROL COMMISSION
Supplemental Form:
License Representative Authorization
What is this form?
An applicant or licensee may give a representative authorization to make changes to the license or application on behalf
of the licensee or to receive information about a license or application. The applicant or licensee may use this form to
document that authorization.
Note: This form must be signed by someone who is a licensee or an applicant for the license. If this form is sent to OLCC
via email, it must come from an email address that is already associated with the license or application.
Section 1 – Applicant/Licensee Information
Application/License ID:
Applicant/Licensee Name:
Section 2 – Representative Information
Representative Name:
Representative Phone:
Representative Email:
Section 3 – Authorization
I give permission for the above-named representative to:
Make changes regarding this license/application on my behalf.
Receive information about the status of the license/application, including information about
pending compliance action or communications between OLCC and the licensee/applicant.
This authorization will remain in effect until I rescind my permission in writing and provide a copy to
the Commission.
Comments:
Signature:
Date:
Name:
Title:
[FORM MJ 18-1203] mj_opt_all_auth (revised 20190415) Page 1 of 1