Application For Liquor License Railroad Airline Checklist {114}

APPLICATION FOR LIQUOR LICENSE RAILROAD, AIRLINE 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 §53-123.05 ­ Railroad or airline license; rights of license (1) The commission may issue a license to any airline company, dining car company, sleeping car company, or railroad company operating in this state which authorizes the holder thereof to keep for sale and to sell or dispense alcoholic liquor for consumption in its airplanes, dining cars, sleeping cars, buffet cars, observation cars, and any other cars used for transportation or accommodation of passengers. Each such company shall keep a duplicate of such license posted in each car or airplane where such alcoholic liquor is served. (2) Every such license shall expire on April 30 of each year. Each such license shall be good throughout this state as a state license. Only one such license shall be required for all cars or airplanes operated in this state by the same owner. No further license shall be required or tax levied by any county, city, or village for the privilege of selling or dispensing alcoholic liquor for consumption in such cars or airplanes. Nothing in the Nebraska Liquor Control Act shall apply to or affect the right of holders of such licenses to transport within this state or to import into this state alcoholic liquor to be kept for dispensing or sale or to be sold while actually en route in the cars or airplanes of such licensees. Applicant Name ________________________________________________________________ Name of Contact Person __________________________________________________________ a. Phone number of Contact Person ______________________________________ 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. 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. ____________________________________________________________________ Authorized Signature ____________________________________________________________________ Print Name ____________________________________________ Date FORM 114 REV 11/2010 PAGE 1 American LegalNet, Inc. www.FormsWorkFlow.com APPLICATION FOR LIQUOR LICENSE RAILROAD, AIRLINE 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 Type of License: Class R Railroad Application fee $45 plus licensee fee $100 Total $145 (checks payable to Nebraska Liquor Control Commission) Application fee $45 plus licensee fee $100 Total $145 (checks payable to Nebraska Liquor Control Commission) Class P Airline Duplicate Licenses Each such company shall keep a duplicate of such license posted in each car or airplane where such alcoholic liquor is served. DUPLICATE LICENSE $1.00/per duplicate Number of Duplicates: ______________ Total Amounted Due: $______________ CHECK TYPE OF LICENSE FOR WHICH YOU ARE APPLYING Sole Proprietor (individual) complete section A Partnership License complete section B Corporate License complete section C Limited Liability Company (LLC) complete section D FORM 114 REV 11/2010 PAGE 2 American LegalNet, Inc. www.FormsWorkFlow.com PREMISE INFORMATION Trade Name (doing business as)____________________________________________________________________ Street Address #1________________________________________________________________________________ Street Address #2________________________________________________________________________________ City__________________________________County____________________________Zip Code________________ Web address: ___________________________________________________________________________________ Mailing address (where you want to receive mail from the Commission) Name__________________________________________________________________________________________ Street Address #1________________________________________________________________________________ Street Address #2________________________________________________________________________________ City___________________________________State____________________________Zip Code________________ SOLE PROPRIETOR (INDIVIDUAL) ­ SECTION A Individual Name_________________________________________________________________________________ Date of Birth_______________________________ Social Security Number_________________________________ Home phone number _______________________________________ Home address _____________________________________________ City _________________________________ State ____________________________________________________ Zip Code _____________________________ E-mail Address ____________________________________________ PARTNERSHIP ­ SECTION B Managing Partner Name___________________________________________________________________________ Date of Birth_______________________________ Social Security Number_________________________________ Home phone number _______________________________________ Home address _____________________________________________ City _________________________________ State ____________________________________________________ Zip Code _____________________________ E-mail Address ____________________________________________ FORM 114 REV 11/2010 PAGE 3 American LegalNet, Inc. www.FormsWorkFlow.com CORPORATION ­ SECTION C Name of Corporation _____________________________________________________________________________ Corporation Address _____________________________________________________________________________ City _________________________________________ State _________________ Zip Code ___________________ Corporation Phone Number ____________________________________ Total number of shares issued out _____________________________ President/CEO Name_____________________________________________________________________________ Date of Birth____________________________