APPLICATION FOR LIQUOR LICENSE CHECKLIST 301 CENTENNIAL MALL SOUTH PO BOX 95046 LINCOLN, NE 68509-5046 PHONE: (402) 471-2571 FAX: (402) 471-2814 Website: www.lcc.ne.gov Applicant Name _________________________________________________________________________ Trade Name __________________________________Previous Trade Name ________________________ E-Mail 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 Each item must be checked and included with application or marked N/A (not applicable) _____ 1. 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. _____ 2. Enclose registration fee for the appropriate class of license, made out to the Nebraska Liquor Control Commission. _____ 3. Enclose the appropriate application forms; Individual License – Form 1; Partnership License – Form 2; Corporate - Form 3a; Limited Liability Form (LCC) – Form 3b. Corporate Form 3a and LLC Form 3b requires Corporate Manager application – Form 3c. _____ 4. If building is being leased send a copy of the lease. Be sure it reads in the individual(s), corporate or LLC name being applied for. Also, the lease must extend through the license year being applied for. If building owned, send a copy of the deed or purchase agreement in appropriate name. _____ 5. If you are buying the business of a current licensee, provide a copy of the purchase agreement from licensee. This also needs to be in appropriate applicant’s name. American LegalNet, Inc. www.FormsWorkflow.com _____ 6. If wishing to run on current liquor license enclose temporary agency agreement (must be Commission form only, must include copy of signature card from the bank showing both the seller and buyers name on account). _____ 7. Copy of alcohol inventory being purchased. Inventory shall include brand names and container sizes. Inventory may be taken at the time application is being submitted. _____ 8. Enclose a list of any inventory or property owned by other parties that are on the premise. _____ 9. For individual, partnership and LLC enclose proof of citizenship; copy of birth certificate (certificate from the State where born, not hospital certificate), naturalization paper or passport, for all applicants, members and spouses. _____10. If corporation or LLC enclose a copy of articles as filed with the Secretary of States Office. This document must show barcode. 11. Check with local governing bodies for any further requirements or restrictions. 12. If you have a business plan, please submit a copy. 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 45-60 days. Furthermore, I understand that all the information is truthful and I accept all responsibility for any false documents. _________________________________________________ Signature American LegalNet, Inc. www.FormsWorkflow.com APPLICATION FOR LIQUOR LICENSE 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) RETAIL LICENSE(S) Application Fee A BEER, ON SALE ONLY B BEER, OFF SALE ONLY C BEER, WINE & DISTILLED SPIRTS, ON & OFF SALE D BEER, WINE & DISTILLED SPIRITS, OFF SALE ONLY I BEER, WINE & DISTILLED SPIRITS, ON SALE ONLY Class K Catering license (requires catering application form) MISCELLANEOUS L O V W X Y Z Application Fee Craft Brewery (Brew Pub) Boat Manufacturer Alcohol & Spirits Beer (excluding produced by a craft brewery) Beer (excluding produced by a craft brewery) Beer (excluding produced by a craft brewery) Beer (excluding produced by a craft brewery) Beer (excluding produced by a craft brewery) Beer (excluding produced by a craft brewery) Wholesale Beer Wholesale Liquor Farm Winery Micro Distillery $45.00 $45.00 $45.00 $45.00 $45.00 $100.00 Bond Required $295.00 $ 95.00 $1,000 minimum none $1,045.00 $145.00 1 to 100 barrel* $245.00 100 to 150 barrel* $395.00 150 to 200 barrel* $545.00 200 to 300 barrel* $695.00 300 to 400 barrel* $745.00 400 to 500 barrel* $545.00 $795.00 $295.00 $295.00 $1,000 minimum $1,000 minimum $1,000 minimum $1,000 minimum $1,000 minimum $1,000 minimum $1,000 minimum $5,000 minimum $5,000 minimum $1,000 minimum $1,000 minimum Copy of TTB permit (if applying for L, V, W, X, Y or Z) *daily capacity, average daily barrel production for the previous twelve months of manufacturing operation. If no such basis for comparison exists, the manufacturing licensee shall pay in advance for the first year’s operation a fee of five hundred dollars _______________________________________________________________________________________________________________ All Class C licenses expire October 31st All other licenses expire April 30th Catering license (K) expires same as underlying retail license TYPE OF APPLICATION BEING APPLIED FOR (CHECK ONE) Individual License (requires insert form 1) Partnership License (requires insert form 2) Corporate License (requires insert form 3a & 3c) Limited Liability Company (requires form 3b & 3c) NAME OF PERSON OR FIRM ASSISTING WITH APPLICATION (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 1 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 Mail address (where you want receipt of mail from the commission) Name_______________________________________________________________________________________________ Street Address #1_________________________________________________________________________________________________ Street Address #2_________________________________________________________________________________________________ City_________________________________________State____________________________Zip Code________________ DESCRIPTION AND DIAGRAM OF THE STRUCTURE TO BE LICENSED In the space provided or on an attachment draw the area to be licensed. This should include storage areas, basement, sales areas and areas where consumption or sales of alcohol will take place. If only a portion of the building is to be covered by the license, you must still include dimensions (length x width) of the licensed area as well as the dimensions of the entire building in situations. No blue prints please. Be sure to indicate the direction north and number of floors of the building. **For on-premise consumption liquor licenses minimum standards must be met by providing at least two restrooms American LegalNet, Inc. www.FormsWorkflow.com 2 APPLICANT INFORMATION 1. READ CAREFULLY. ANSWER COMPLETELY AND ACCURATELY. Has anyone who is a party to this application, or their spouse, EVER been convicted of or plead guilty to any charge. Charge means any charge alleging a felony, misdemeanor, violation of a federal or state law; a violation of a local law, ordinance or resolution. List the nature of the charge, where the charge occurred and the year and month of the conviction or plea. Also list any charges pending at the time of this application. If more than one party, please list charges by each individual’s name. YES NO If yes, please explain below or attach a separate page. _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Are you buying the business and/or assets of a licensee? YES NO If yes, give name of business and license number______________________________________________________________ a) Submit a copy of the sales agreement including a list of the furniture, fixtures and equipment. b) Include a list of alcohol being purchased, list the name brand, container size and how many? 2. 3. Are you filing a temporary agency agreement whereby current licensee allows you to operate on their license? YES NO If yes, attach temporary agency agreement form and signature card from the bank. This agreement is not effective until you receive your three (3) digit ID number from the Commission. 4. Are you borrowing any money from any source to establish and/or operate the business? YES NO If yes, list the lender_____________________________________________________________________________________ 5. Will any person or entity other than applicant be entitled to a share of the profits of this business? YES NO If yes, explain. All involved persons must be disclosed on application.____________________________________________ _______________________________________________________________________________________________________________ Will any of the furniture, fixtures and equipment to be used in this business be owned by others? YES NO If yes, list such items and the owner._______________________________________________________________________ 6. ___________________________________________________________________________________________________________________________ 7. Will any person(s) other than named in this application have any direct or indirect ownership or control of the business? YES NO If yes, explain.______________________________________________________________________________________ No silent partners American LegalNet, Inc. www.FormsWorkflow.com 3 8. Are you premises to be licensed within 150 feet of a church, school, hospital, home for the aged or indigent persons or for veterans, their wives, children, or within 300 feet of a college or university campus? YES NO If yes, list the name of such institution and where it is located in relation to the premises (Neb. Rev. Stat. 53-177) ______________________________________________________________________________________________________________ 9. Is anyone listed on this application a law enforcement officer? YES NO If yes, list the person, the law enforcement agency involved and the person’s exact duties_______________________________________________________________________________________________________ 10. List the primary bank and/or financial institution (branch if applicable) to be utilized by the business and the individual(s) who will be authorized to write checks and/or withdrawals on accounts at the institution. _______________________________________________________________________________________________________________ 11. List all past and present liquor licenses held in Nebraska or any other state by any person named in this application. Include license holder name, location of license and license number. Also list reason for termination of any license(s) previously held. _______________________________________________________________________________________________________________ 12. List the training and/or experience (when and where) of the person(s) making application. Those persons required are listed as followed: a) Individual, applicant only (no spouse) b) Partnership, all partners (no spouses) c) Corporation, manager only (no spouse) d) Limited Liability Company, manager only (no spouse) Name: Date: Where: 13. If the property for which this license is sought is owned, submit a copy of the deed, or proof of ownership. If leased, submit a copy of the lease covering the entire license year. Documents must show title or lease held in name of applicant as owner or lessee in the individual(s) or corporate name for which the application is being filed. Lease: expiration date_________________________________________________________________________ Deed Purchase Agreement 14. When do you intend to open for business? ________________________________________________________________ 15. What will be the main nature of business? ________________________________________________________________ 16. What are the anticipated hours of operation? ______________________________________________________________ 17. List the principal residence(s) for the past 10 years for all persons required to sign, including spouses. If necessary attach a separate sheet. RESIDENCES FOR THE PAST 10 YEARS, APPLICANT AND SPOUSE MUST COMPLETE APPLICANT: CITY & STATE YEAR FROM TO SPOUSE: CITY & STATE YEAR FROM TO American LegalNet, Inc. www.FormsWorkflow.com 4 The undersigned applicant(s) hereby consent(s) to an investigation of his/her background investigation and release present and future records of every kind and description including police records, tax records (State and Federal), and bank or lending institution records, and said applicant(s) and spouse(s) waive(s) any right or causes of action that said applicant(s) or spouse(s) may have against the Nebraska Liquor Control Commission, the Nebraska State Patrol, and any other individual disclosing or releasing said information Any documents or records for the proposed business or for any partner or stockholder that are needed in furtherance of the application investigation of any other investigation shall be supplied immediately upon demand to the Nebraska Liquor Control Commission or the Nebraska State Patrol. The undersigned understand and acknowledge that any license issued, based on the information submitted in this application, is subject to cancellation if the information contained herein is incomplete, inaccurate or fraudulent. Individual applicants agree to supervise in person the management and operation of the business and that they will operate the business authorized by the license for themselves and not as an agent for any other person or entity. Corporate applicants agree the approved manager will superintend in person the management and operation of the business. Partnership applicants agree one partner shall superintend the management and operation of the business. All applicants agree to operate the licensed business within all applicable laws, rules regulations, and ordinances and to cooperate fully with any authorized agent of the Nebraska Liquor Control Commission. Must be signed in the presence of a notary public by applicant(s) and spouse(s). If partnership or LLC (Limited Liability Company), all partners, members and spouses must sign. If corporation all officers, directors, stockholders (holding over 25% of stock and spouses). Full (birth) names only, no initials. ________________________________________ Signature of Applicant ______________________________________ Signature of Spouse ________________________________________________ Signature of Applicant ______________________________________________ Signature of Spouse ________________________________________________ Signature of Applicant ______________________________________________ Signature of Spouse ________________________________________________ Signature of Applicant ______________________________________________ Signature of Spouse ________________________________________________ Signature of Applicant _____________________________________________ Signature of Spouse State of Nebraska County of ___________________________________ County of ____________________________________ The foregoing instrument was acknowledged before me this _____________________ by The foregoing instrument was acknowledged before me this ____________________ by _____________________________________________ ________________________________________ _____________________________________________ Notary Public signature ______________________________________________ Notary Public signature Affix Seal Here Affix Seal Here in compliance with the ADA, this manager insert form 3c is available in other formats for persons with disabilities. A ten day advance period is required in writing to produce the alternate format. American LegalNet, Inc. www.FormsWorkflow.com 5