Application For Liquor License Retail {100}

APPLICATION FOR LIQUOR LICENSE CHECKLIST - RETAIL 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 Initial Applicant name ______________________________________________________________________________ Trade name _________________________________________________________________________________ Previous trade name __________________________________________________________________________ Contact email 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 Nebraska Liquor Control Commission. Office use only PAYMENT TYPE ______________________ BARCODE AMOUNT: ______________________ REQUIRED ATTACHMENTS Received: ______ Each item must be checked and included with application or marked N/A (not applicable) American LegalNet, Inc. www.FormsWorkFlow.com FORM 100 REV FEB 2017 PAGE 1 1. _____Fingerprints are required for each person as defined in new application guide, found on our website under "Licensing Tab" in "Guidelines/Brochures". See Form 147 for further information, this form MUST be included with your application. 2. _____Enclose application fee of $400 (nonrefundable), check made payable to the Nebraska Liquor Control Commission or you may pay online at PAYPORT. 3. _____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) 4. _____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 (LLC) making application. Lease term must run through the license year being applied for. 5. _____If building is owned or being purchased send a copy of the deed or purchase agreement in the name of the applicant. 6. _____If buying the business of a current liquor license holder: a. Provide a copy of the purchase agreement from the seller (must read applicants name) b. Provide a copy of alcohol inventory being purchased (must include brand names and container size) c. Enclose a list of the assets being purchased (furniture, fixtures and equipment) 7. _____If requesting to operate on current liquor license; enclose Temporary Operating Permit (TOP) (Form 125). 8. _____Enclose a list of any inventory or property owned by other parties that are on the premises. 9. _____For citizenship enclose U.S. birth certificate; U.S. passport or naturalization paper a. For residency enclose proof of registered voter in Nebraska b. If permanent resident include Employment Authorization Card or Permanent Resident Card c. See guideline for further assistance 10. _____Corporation or Limited Liability Company (LLC) must enclose a copy of articles of incorporation; as filed with the Secretary of State's Office. 11. _____Submit a copy of your business plan. 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. _________________________________________________________ Signature ___________________ Date American LegalNet, Inc. www.FormsWorkFlow.com FORM 100 REV FEB 2017 PAGE 2 APPLICATION FOR LIQUOR LICENSE RETAIL 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 RETAIL LICENSE(S) _____ A _____ B _____ C _____ D _____ I ______ J _____ AB _____ AD _____ IB Application Fee $400 (nonrefundable) BEER, ON SALE ONLY BEER, OFF SALE ONLY BEER, WINE, DISTILLED SPIRTS, ON AND OFF SALE BEER, WINE, DISTILLED SPIRITS, OFF SALE ONLY BEER, WINE, DISTILLED SPIRITS, ON SALE ONLY LIMITED ALCOHOLIC LIQUOR, OFF SALE ­ MUST INCLUDE SUPPLEMENTAL FORM 120 BEER, ON AND OFF SALE BEER ON SALE ONLY, BEER, WINE, DISTILLED SPIRITS OFF SALE BEER, WINE, DISTILLED SPIRITS ON SALE, BEER OFF SALE ONLY _____ Class K Catering license (requires catering application form 106) $100.00 Additional fees will be assessed at city/village or county level when license is issued Class C license term runs from November 1 ­ October 31 All other licenses run from May 1 ­ April 30 Catering license (K) expires same as underlying retail license 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 form 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___________________________________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com FORM 100 REV FEB 2017 PAGE 3 PREMISES INFORMATION Trade Name (doing business as) ___________________________________________________________________________ Street Address #1______________________________________________________________________________________ Street Address #2_____________________________________________________________