Application For Liquor License Checklist Farm Winery {126}

APPLICATION FOR LIQUOR LICENSE CHECKLIST ­ FARM WINERY 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 Hot List: YES / NO License Number New/Replacing # Initial 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) Application fee $400 plus licensee fee $250 (non refundable) Total $650 (check payable to 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 (May use form 115) _____ 4) Submit diagram (plat/plan) to include: a. Facility dimensions and description b. Identify production area c. Any storage areas d. Grounds to include vineyards, sheds, etc, _____ 5) Copy of business plan _____ 6) Name of Wine Maker ________________________________________________________________ a. Phone number of Wine Maker ____________________________________________________ _____ 7) Be advised that this application will be set for hearing before the Nebraska Liquor Control Commission to determine if the license should be issued. _____ 8) 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. FORM 126 REV AUG 2016 PAGE 1 American LegalNet, Inc. www.FormsWorkFlow.com _____ 9) Enclose the appropriate application forms; 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) _____ 10) 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. _____ 11) 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 American LegalNet, Inc. www.FormsWorkFlow.com FORM 126 REV AUG 2016 PAGE 2 APPLICATION FOR LIQUOR LICENSE FARM WINERY 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 Y Farm Winery Application fee $400 plus licensee fee $250 (non refundable) Total $650 (checks payable to Nebraska Liquor Control Commission) Class K Catering license (requires catering application form 106) $100.00 Copy of Federal Basic Permit Alcoholic Liquor Tax Bond minimum of $1,000 (form 115 may be used) Additional fees may be assessed at city/village or county level when license is issued Term of license runs from May 1 ­ April 30 Catering license (K) expires same as farm winery license 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________________________________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com FORM 126 REV AUG 2016 PAGE 3 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: YES NO Mailing address (where you want to receive mail from the Commission) Name_______________________________________________________________________________________________ Street Address #1______________________________________________________________________________________ Street Address #2____________________________________________________