Nebraska > Statewide > Liquor Control Commission
Application For Deletion To Liquor License 112 - Nebraska
| Application For Deletion To Liquor License Form. This is a Nebraska form and can be used in Liquor Control Commission Statewide . |
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APPLICATION FOR DELETION TO LIQUOR LICENSE NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH PO BOX 95046 LINCOLN, NE 68509-5046 PHONE: (402) 471-2571 FAX: (402) 471-2814 Website: www.lcc.ne.gov Office Use Application: x Must include processing fee of $45.00 made payable to Nebraska Liquor Control Commission x Must include simple sketch showing existing licensed area and area to be deleted, include dimensions in feet (not square feet), direction north. No blue prints. x May include a letter of explanation LIQUOR LICENSE #_____________________________________ LICENSEE NAME__________________________________________________________________________ TRADE NAME_____________________________________________________________________________ PREMISE ADDRESS________________________________________________________________________ CITY______________________________________________________________________________________ CONTACT PERSON________________________________________________________________________ PHONE NUMBER OF CONTACT PERSON ____________________________________________________ ______________________________________________________________ Print Name of Signature _____________________________________________________________ Signature of Licensee or Officer State of Nebraska County of_____________________________________________________ The forgoing instrument was acknowledge before me this ____________________________________ Date ______________________________________________________________ Notary Public Signature Affix Seal Here American LegalNet, Inc. www.FormsWorkFlow.com
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