APPLICATION FOR ENTERTAINMENT DISTRICT LICENSE NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH, 5TH FLOOR PO BOX 95046 LINCOLN, NE 68509-5046 PHONE: (402) 471-2571 FAX: (402) 471-2814 OR (402) 471-2374 Website: www.lcc.nebraska.gov Office Use Application: Must include local governing body's designated area to be used as a common area for consumption Must include simple sketch showing existing licensed area and area to be used as commons area include feet (not square feet), direction north. No blue prints. Must include picture of logo used on containers serving alcohol (containers must prominently displays the licensee's trade name or logo or some other mark that is unique to the licensee) CLASS OF LICENSE AND NUMBER (if any)_________________________________________ NAME OF LICENSEE ____________________________________________________________ TRADE NAME __________________________________________________________________ PREMISE ADDRESS _____________________________________________________________ CITY/STATE/ZIP CODE __________________________________________________________ A copy of this application will be forwarded to the local governing body for their recommendation as per Neb Rev Stat �53-132. Upon receipt of recommendation issuance shall be held for a 10 day protest period, if no protests received license will be issued and mail to the clerk's office for pick up and payment of fees. A license fee of $300 plus any occupation tax shall be paid to the local governing body at time of issuance in addition to underlying liquor license costs. _______________________________________________ Signature of licensee Office use only PAYMENT TYPE ______________________ AMOUNT: ___________________________ Received: _________ BARCODE FORM 136 REV JUNE 2015 American LegalNet, Inc. www.FormsWorkFlow.com