APPLICATION FOR AMENDING APPLICATION 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/ ________________________________________________________________________________________________________ Licensee Name Liquor License Number _______________________________________________________________________________________ Premises Address City Zip Code ________________________________________________________________________________________________________ Contact Name Contact Telephone Number TYPE OF AMENDMENT Change in area to be licensed, attach copy of new sketch with amended area, and be clear as to what is being changed Change to question #______ of application Change in stockholders, attach affidavit for change of corporate officers and/or stockholder Change in membership, attach affidavit for change of limited liability company (LLC) member Other, please attached explanation of request Only one amended is allowed per application. Any major change to an application must be made by withdrawing (in writing) the current application and filing a new application. ___________________________________________________________________ Signature ________________________________________ Date American LegalNet, Inc. www.FormsWorkFlow.com FORM 151 REV FEB 2017