Application For Liquor License Limited Partnership {119}

APPLICATION FOR LIQUOR LICENSE LIMITED PARTNERSHIP INSERT ­ FORM 2b 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 Office Use All Partners, including spouses, are required to adhere to the following requirements 1) 2) 3) 4) Must be a citizen of the United States At least one (1) partner must be a Nebraska resident (Chapter 2 ­ 006) Must provide a copy of their certified birth certificate or INS papers, or US Passport Fingerprints are required. See Form 147 for further information, this form MUST be included with your application 5) Must sign the signature page of the Application for License form 6) Primary Partner may be required to take a training course Name of Primary Partner: Last Name:__________________________________________________________________________ First Name:______________________________________________________ MI:_________________ Home Address:_________________________________________ City:__________________________ Social Security Number:_____________________________ Date of Birth:_______________________ Home Telephone Number:______________________________________________________________ Driver's License Number: _______________________________________ State:___________________ Are you married? (Please call the NLCC office for special circumstances such as separations, etc) YES NO If yes, provide your spouse's information below Spouses Last Name: ___________________________________________________________________ Spouses First Name:______________________________________________ MI:_________________ Social Security Number:_____________________________ Date of Birth:_______________________ Driver's License Number: _______________________________________ State:___________________ Form 119 REV APR 2015 Page 1 American LegalNet, Inc. www.FormsWorkFlow.com Name of Partner: Last Name:__________________________________________________________________________ First Name:______________________________________________________ MI:_________________ Home Address:_________________________________________ City:__________________________ Social Security Number:_____________________________ Date of Birth:_______________________ Home Telephone Number:______________________________________________________________ Driver's License Number: _______________________________________ State:___________________ Are you married? (Please call the NLCC office for special circumstances such as separations, etc) YES NO If yes, provide your spouse's information below Spouses Last Name: ___________________________________________________________________ Spouses First Name:______________________________________________ MI:_________________ Social Security Number:_____________________________ Date of Birth:_______________________ Driver's License Number: _______________________________________ State:___________________ In compliance with the ADA, this partnership insert form is available in other formats for persons with disabilities. A ten day advance period is requested in writing to produce the alternate format. Form 119 REV APR 2015 Page 2 American LegalNet, Inc. www.FormsWorkFlow.com