Attachment a (applicant and ownership entities) - State of Michigan 2025

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The document is an authorization form for the Michigan Gaming Control Board, requiring applicants and entities with 25% or more ownership interest to consent to a background investigation. It includes sections for the entity's name, authorized agent's details, and notary acknowledgment, allowing the release of information from various government agencies.
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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering the name of the entity in the designated field. Ensure accuracy as this is crucial for identification.
  3. In the next section, provide the name and title of the person authorized to execute the release. This individual must have the authority to act on behalf of the entity.
  4. Review and complete the consent statement, ensuring that all necessary authorizations are clearly stated. This includes allowing background checks by the Michigan Gaming Control Board.
  5. Sign and date the form where indicated. The signature must be from an authorized agent of the entity.
  6. Lastly, ensure that a Notary Public witnesses your signature. Fill in their details and commission expiration date as required.

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