FOR OFFICE USE ONLY STICKER #: PAID: Corp. & Trade Name Nebraska Liquor License # Address City, State, Zip Code Line 1 How many books? X $10.00 = $ Line 2 State Sales Tax $ Line 1 X $0.055 Line 3 City Sales Tax (if applicable) $ Line 1 X city rate below Line 4 TOTAL DUE $ Add lines 1, 2, and 3 AINSWORTH 0.015 CLARKSON 0.015 GORDON 0.01 MCCOOK 0.015 RED CLOUD 0.015 ALBION 0.015 CLAY CENTER 0.01 GOTHENBURG 0.015 MCCOOL JUNCTION 0.015 REPUBLICAN CITY 0.01 ALLIANCE 0.015 CLEARWATER 0.015 GRAND ISLAND 0.015 MEADOW GROVE 0.015 RUSHVILLE 0.015 ALMA 0.02 COLUMBUS 0.015 GRANT 0.01 MILFORD 0.01 SARGENT 0.015 ARAPAHOE 0.01 CORDOVA 0.01 GREELEY 0.01 MINDEN 0.02 SCHUYLER 0.015 ARCADIA 0.01 CORTLAND 0.01 GREENWOOD 0.01 MITCHELL 0.015 SCOTTSBLUFF 0.015 ARLINGTON 0.015 COZAD 0.015 GRESHAM 0.015 MONROE 0.015 SCRIBNER 0.015 ARNOLD 0.01 CRAWFORD 0.015 GRETNA 0.015 MORRILL 0.01 SEWARD 0.015 ASHLAND 0.015 CREIGHTON 0.01 GUIDE ROCK 0.01 MULLEN 0.01 SIDNEY 0.02 ATKINSON 0.015 CRETE 0.02 HARRISON 0.01 MURRAY 0.01 SILVER CREEK 0.01 AUBURN 0.01 CROFTON 0.01 HARTINGTON 0.01 NEBRASKA CITY 0.02 SOUTH SIOUX CITY 0.015 BANCROFT 0.015 CURTIS 0.01 HARVARD 0.01 NELIGH 0.01 SPENCER 0.01 BASSETT 0.015 DAKOTA CITY 0.005 HASTINGS 0.015 NELSON 0.01 SPRINGFIELD 0.015 BATTLE CREEK 0.015 DAKOTA COUNTY 0.005 HAY SPRINGS 0.01 NEWMAN GROVE 0.015 SPRINGVIEW 0.01 BAYARD 0.01 DANNENBROG 0.01 HEBRON 0.01 NIOBRARA 0.01 STANTON 0.015 BEATRICE 0.015 DAVID CITY 0.02 HEMINGFORD 0.015 NORFOLK 0.015 ST EDWARD 0.01 BEAVER CITY 0.01 DAYKIN 0.01 HENDERSON 0.015 NORTH BEND 0.015 ST PAUL 0.01 BEAVER CROSSING 0.01 DECATUR 0.01 HICKMAN 0.015 NORTH PLATTE 0.015 STERLING 0.01 BEEMER 0.015 DEWEESE 0.01 HILDRETH 0.01 OAKLAND 0.01 STROMSBURG 0.015 BELLEVUE 0.015 DILLER 0.01 HOLDREGE 0.015 OCONTO 0.01 STUART 0.015 BELLWOOD 0.015 DODGE 0.015 HOOPER 0.01 ODELL 0.01 SUPERIOR 0.01 BENEDICT 0.015 DONIPHAN 0.01 HOWELLS 0.015 OGALLALA 0.015 SUTTON 0.015 BENKELMAN 0.015 DOUGLAS 0.015 HUBBELL 0.01 OMAHA 0.015 SYRACUSE 0.01 BENNET 0.01 DUNCAN 0.015 HUMPHREY 0.015 O'NEILL 0.015 TECUMSEH 0.015 BENNINGTON 0.015 EAGLE 0.01 HYANNIS 0.01 ORD 0.015 TEKAMAH 0.02 BERTRAND 0.01 EDGAR 0.01 IMPERIAL 0.01 OSCEOLA 0.015 TERRYTOWN 0.01 BIG SPRINGS 0.01 EDISON 0.01 JACKSON 0.015 OSHKOSH 0.02 TILDEN 0.015 BLAIR 0.015 ELGIN 0.01 JANSEN 0.01 OSMOND 0.01 UEHLING 0.01 BLOOMFIELD 0.01 ELM CREEK 0.01 JUNIATA 0.01 OXFORD 0.015 UPLAND 0.005 BLUE HILL 0.015 ELMWOOD 0.015 KEARNEY 0.015 PALMYRA 0.01 UTICA 0.015 BRAINARD 0.01 ELWOOD 0.01 KIMBALL 0.015 PAPILLION 0.02 VALENTINE 0.015 BRIDGEPORT 0.01 EUSTIS 0.01 LA VISTA 0.02 PAWNEE CITY 0.02 VALLEY 0.015 BROKEN BOW 0.015 EXETER 0.015 LAWRENCE 0.01 PAXTON 0.01 VERDIGRE 0.015 BROWNVILLE 0.01 FAIRBURY 0.02 LEIGH 0.015 PERU 0.01 WAHOO 0.02 BURWELL 0.015 FAIRFIELD 0.015 LEWELLEN 0.01 PETERSBURG 0.01 WAKEFIELD 0.01 CAIRO 0.01 FALLS CITY 0.015 LEXINGTON 0.015 PIERCE 0.01 WATERLOO 0.02 CALLAWAY 0.01 FARNAM 0.01 LINCOLN 0.015 PILGER 0.015 WAUSA 0.01 CAMBRIDGE 0.015 FORT CALHOUN 0.015 LINWOOD 0.01 PLAINVIEW 0.015 WAVERLY 0.01 CEDAR RAPIDS 0.01 FRANKLIN 0.01 LOOMIS 0.01 PLATTE CENTER 0.015 WAYNE 0.015 CENTRAL CITY 0.015 FREMONT 0.015 LOUISVILLE 0.015 PLATTSMOUTH 0.015 WEEPING WATER 0.015 CERESCO 0.015 FRIEND 0.01 LOUP CITY 0.015 PLYMOUTH 0.015 WEST POINT 0.015 CHADRON 0.02 FULLERTON 0.015 LYONS 0.015 PONCA 0.015 WILBER 0.015 CHAMBERS 0.01 GENEVA 0.02 MADISON 0.015 RALSTON 0.015 WISNER 0.02 CHAPPELL 0.02 GENOA 0.015 MALCOLM 0.01 RANDOLPH 0.02 WOOD RIVER 0.015 CHESTER 0.01 GERING 0.015 MARQUETTE 0.015 RAVENNA 0.015 WYMORE 0.015 CLARKS 0.01 GIBBON 0.01 MAYWOOD 0.015 YORK 0.02 x-noneKEG BOOK ORDER FORM x-noneCITY SALES TAX TABLE x-noneP.O. BOX 95046 x-noneEFFECTIVE 02/01/2019 x-noneIn compliance with ADA, this form is available in other formats for persons with disabilities.A ten day advance period is requested in writing to produce the alternate format. x-noneIf submitting this form via email, please send to nlcc.beerdesk@nebraska.gov x-nonePay by credit card or EFT through PayPort at www.ne.gov/go/NLCCpayport x-noneor make checks payable to: x-noneNEBRASKA LIQUOR CONTROL COMMISSION x-noneLINCOLN, NE 68509 x-noneDO NOT SEND CASH FORM 35-7129 American LegalNet, Inc. www.FormsWorkFlow.com