Controlling Corporation Insert {185}

CONTROLLING CORPORATION INSERT 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 Attach copy of Articles as filed with the Nebraska Secretary of State - §53-126 Name and address of the controlling corporation of the applying corporation Controlling Corporation Name: _______________________________________________________________________ Controlling Corporation Address:______________________________________________________________________ City:_______________________________________ State:___________________ Zip Code:______________________ Provide the names of the top four officer/members of the controlling corporation 1. Full Name: _________________________________________________________________________________ Job Title: _______________________________________________________________________________ 2. Full Name: _________________________________________________________________________________ Job Title: _______________________________________________________________________________ 3. Full Name: _________________________________________________________________________________ Job Title: _______________________________________________________________________________ 4. Full Name: _________________________________________________________________________________ Job Title: _______________________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com FORM 185 NOV 2015 Page 1