Nebraska > Statewide > Liquor Control Commission
Application For Liquor License Wholesale 128 - Nebraska
| Application For Liquor License Wholesale Form. This is a Nebraska form and can be used in Liquor Control Commission Statewide . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
APPLICATION FOR LIQUOR LICENSE WHOLESALE CHECKLIST 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 Applicant Name ___________________________________________________________________ E-Mail Address: ___________________________________________________________________ Web Site Address: _________________________________________________________________ Provide all the items requested. Failure to provide any item will cause this application to be returned or placed on hold. All documents must be legible. Any false statement or omission may result in the denial, suspension, cancellation or revocation of your license. If your operation depends on receiving a liquor license, the Nebraska Liquor Control Commission cautions you that if you purchase, remodel, start construction, spend or commit money that you do so at your own risk. Prior to submitting your application review the application carefully to ensure that all sections are complete, and that any omissions or errors have not been made. You may want to check with the city/village or county clerk, where you are making application, to see if any additional requirements must be met before submitting application to the state. REQUIRED ATTACHMENTS ______ 1) Enclose application fee plus license fee check made payable to the Nebraska Liquor Control Commission. _____ 2) Copy of Federal Basic Permit issued by Alcohol and Tobacco Tax and Trade Bureau (TTB) _____ 3) Alcoholic Liquor Tax Bond, $5,000 minimum including the Power of Attorney documentation (May use form 115) _____ 4) Submit diagram to include: a. Facility dimensions and description b. Identify production area c. Any storage area _____ 5) Copy of business plan _____ 6) Fingerprint cards for each person (two cards per person) must be enclosed with a check payable to the Nebraska State Patrol for processing in the amount of $38.00 per person. All areas must be completed on cards as per brochure. To prevent the delay in issuing your license, we strongly suggest you go to any Nebraska State Patrol office or law enforcement agency listed in the enclosed fingerprint brochure. _____ 7) Enclose the appropriate application forms Individual License Individual License (requires insert form 1) Partnership License (requires insert form 2) Corporate License (requires insert form 3a & 3c) Limited Liability Company (LLC) (requires form 3b & 3c) FORM 128 REV 5/2012 PAGE 1 American LegalNet, Inc. www.FormsWorkFlow.com _____ 8) If building is being leased send a copy of signed lease. Be sure the lease reads in the name of the individual(s), corporation or Limited Liability Company making application. Lease term must run through the license year being applied for. _____ 9) Corporation or Limited Liability Company must enclose a copy of articles of incorporation; as filed with the Secretary of State's Office. This document must show barcode. I acknowledge that this application is not a guarantee that a liquor license will be issued to me, and that the average processing period is 60 days. Furthermore, I understand that all the information is truthful and I accept all responsibility for any false documents. ____________________________________________________________________ Authorized Signature ____________________________________________________________________ Print Name ____________________________________________________________________ Contact Phone Number ____________________ Date FORM 128 REV 5/2012 PAGE 2 American LegalNet, Inc. www.FormsWorkFlow.com APPLICATION FOR LIQUOR LICENSE WHOLSALE 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/ CLASS OF LICENSE FOR WHICH APPLICATION IS MADE AND FEES CHECK DESIRED CLASS(S) Class W Wholesale Beer Application fee $45 plus licensee fee $500 Total $545 (checks payable to Nebraska Liquor Control Commission) Territory agreement enclosed, see §53-123.03 Class X Wholesale Liquor Application fee $45 plus licensee fee $750 Total $795 (checks payable to Nebraska Liquor Control Commission) Copy of Federal Basic Permit Alcoholic Liquor Tax Bond minimum of $5,000 (form 115 may be used) If applying for both beer and spirits a dual bond is acceptable Additional fees may be assessed at city/village or county level when license is issued Term of license runs from May 1 April 30 CHECK TYPE OF LICENSE FOR WHICH YOU ARE APPLYING Individual License (requires insert form 1) Partnership License (requires insert form 2) Corporate License (requires insert form 3a & 3c) Limited Liability Company (LLC) (requires form 3b & 3c) NAME OF ATTORNEY OR FIRM ASSISTING WITH APPLICATION (if applicable) Commission will call this person with any questions we may have on this application Name___________________________________________________ Phone number:________________________________ Firm Name___________________________________________________________________________________________ FORM 128 REV 5/2012 PAGE 3 American LegalNet, Inc. www.FormsWorkFlow.com PREMISE INFORMATION Trade Name (doing business as)___________________________________________________________________________ Street Address #1______________________________________________________________________________________ Street Address #2______________________________________________________________________________________ City________________________________________County____________________________Zip Code________________ Premise Telephone number_____________________________________ Is this location inside the city/village corporate limits: Mailing address (where you want to receive mail from the Commission) Name_______________________________________________________________________________________________ Street Address #1______________________________________________________________________________________ Street Address #2______________________________________________________________________________________ City_________________________________________State____________________________Zip Code________________ YES NO DESCRIPTION AND DIAGRAM OF THE STRUCTURE TO BE LICENSED READ CAREFULLY In the space provided or on an attachment draw the area to be licensed. This should include storage areas, basement, outdoor area, sales areas and areas where sampling or sales of alcohol will take place. If on
|
|||||||
