Applicaton For Liquor License Manufacturer {129}

APPLICATION FOR LIQUOR LICENSE APPLICATION FOR LIQUOR LICENSE MANUFACTURER 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.nebraska.gov Hot List Yes / No Class Type New Replacing #: License Number Initials Applicant Name _______________________________________________________________________________________ Trade 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 Manufacture means to distill, rectify, ferment, brew, make, mix, concoct, process, blend, bottle, or fill an original package with any alcoholic liquor and includes blending but does not include the mixing or other preparation of drinks for serving by those persons authorized and permitted in the Nebraska Liquor Control Act to serve drinks for consumption on the premises where sold. ______ 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, $1,000 minimum including the Power of Attorney documentation FORM 115 OFFICE USE ONLY PAYMENT TYPE:_______________________________ AMOUNT:_____________________________________ RECEIVED BY:_________________________________ RECEIPT #:____________________________________ BARCODE American LegalNet, Inc. www.FormsWorkFlow.com FORM 129 REV APRIL 2016 PAGE 1 _____ 4) Submit diagram to include: a. Facility dimensions and description b. Identify production area c. Any storage area _____ 5) Copy of your detailed business plan _____ 6) Fingerprints are required for each person as defined in new application guideline. See FORM 147 for further information, this form MUST be included with your application _____ 7) Enclose the appropriate application forms Individual License (requires insert 1- FORM 104) Partnership License (requires insert 2 ­ FORM 105) Corporate License (requires insert 3A ­ FORM 101 & 3C FORM 103) Limited Liability Company (LLC) (requires insert 3B ­ FORM 102 & 3C FORM 103) _____ 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. 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 American LegalNet, Inc. www.FormsWorkFlow.com FORM 129 REV APRIL 2016 PAGE 2 APPLICATION FOR LIQUOR LICENSE MANUFACTURER 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.nebraska.gov/ CLASS OF LICENSE FOR WHICH APPLICATION IS MADE AND FEES CHECK DESIRED CLASS Class V Manufacturer License Application fee of $45 plus licensee fee based on the following (Check made payable to Nebraska Liquor Control Commission) or pay online at PAYPORT License Fee Alcohol and Spirits $1,000 Beer ­ tier one 1 to 100 barrel daily capacity or any part thereof $ 100 $ 200 Beer ­ tier two 100 to 150 barrel daily capacity Beer ­ tier three 150 to 200 barrel daily capacity $ 350 $ 500 Beer ­ tier four 200 to 300 barrel daily capacity Beer ­ tier five 300 to 400 barrel daily capacity $ 650 Beer ­ tier six 400 to 500 barrel daily capacity $ 700 $ 800 Beer ­ tier seven 500 daily barrel capacity or more Wine $ 250 ____ ____ ____ ____ ____ ____ ____ ____ ____ Definition for beer only - for purposes of this subsection, daily capacity means the average daily barrel production for the previous twelve months of manufacturing operation. If no such basis for comparison exists, the manufacturing licensee shall pay in advance for the first year's operation a fee of five hundred dollars. ____ ____ Copy of Federal Basic Permit application as filed with Alcohol and Tobacco Tax and Trade Bureau (TTB) Alcoholic Liquor Tax Bond, $1,000 minimum including the Power of Attorney documentation May use FORM 115 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 1- FORM 104 Partnership License (requires insert 2 ­ FORM 105) Corporate License (requires insert 3A ­ FORM 101 & 3C FORM 103) Limited Liability Company (LLC) (requires insert 3B ­ FORM 102 & 3C FORM 103) 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_________________________________