APPLICATION FOR LIQUOR LICENSE CRAFT BREWERY (BREWPUB) CHECKLIST 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 Website: www.lcc.nebraska.gov HOT LIST: YES/NO NEW/REPLACING # CLASS TYPE LICENSE NUMBER INITIAL Applicant Name ______________________________________________________________________________________ E-Mail Address: ______________________________________________________________________________________ Web Site 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 ______ 1) Application fee $400 plus licensee fee $250 Total $650 (check payable to Nebraska Liquor Control Commission) _____ 2) Copy of Brewers Notice Application ­ entire application including the diagram of Federal Bonded Area to be approved by Alcohol and Tobacco Tax and Trade Bureau (TTB) _____ 3) Alcoholic Liquor Tax Bond, $1,000 minimum including the Power of Attorney documentation (May use form 115) _____ 4) Submit diagram to include: a. Facility dimensions and description b. Identify production area c. Any storage area Office use only PAYMENT TYPE ___________________________ AMOUNT ___________________________ RECEIVED _______________ BARCODE FORM 127 REV AUG 2016 PAGE 1 American LegalNet, Inc. www.FormsWorkFlow.com _____ 5) Copy of business plan _____ 6) Name of Brew Master ________________________________________________________________ a. Phone number of Brew Master ____________________________________________________ _____ 7) Fingerprints are required for each person as defined in new application guide, found on our website under "Licensing Tab" in "Applicant Guidelines". See Form 147 for further information, this form MUST be included with your application. _____ 8) 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) _____ 9) If building is being leased send a copy of signed lease. Be sure the lease reads in the name of the applicant either as individual, partnership, corporation (Inc) or limited liability company (LLC) making application. Lease term must run through the license year being applied for (May 1 ­ April 30). _____ 10) Corporation or Limited Liability Company must enclose a copy of articles of incorporation; as filed with the Nebraska Secretary of State's Office. _____11) License will not be issued until we are in receipt of a copy of your Brewers Notice issued by TTB. 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. ____________________________________________________________________ Authorized Signature ____________________________________________________________________ Print Name ____________________________________________________________________ Contact Phone Number ____________________ Date FORM 127 REV AUG 2016 PAGE 2 American LegalNet, Inc. www.FormsWorkFlow.com APPLICATION FOR LIQUOR LICENSE CRAFT BREWERY (BREWPUB) 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 Website: www.lcc.nebraska.gov/ CLASS OF LICENSE FOR WHICH APPLICATION IS MADE AND FEES CHECK DESIRED CLASS(S) Class L Craft Brewery (Brew Pub) Application fee $400 (nonrefundable) plus licensee fee $250 Total $650 (checks payable to Nebraska Liquor Control Commission) Class K Catering license (requires catering application form 106) $100.00 Copy of Brewer Notice Application ­ entire application including the diagram of Federal Bonded Area to be approved by Alcohol and Tobacco Tax and Trade Bureau (TTB) Alcoholic Liquor Tax Bond minimum of $1,000 (form 115 may be used) Additional fees may be assessed at city/village or county level when license is issued Term of license runs from May 1 ­ April 30 Catering license (K) expires same as craft brewery (brewpub) license CHECK TYPE OF LICENSE FOR WHICH YOU ARE APPLYING 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) 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 127 REV AUG 2016 PAGE 3 PREMISE INFORMATION Trade Name (doing business as)___________________________________________________________________________ Street Address #1______________________________________________________________________________________ Street Address #2______________________________________________________________________________________ City________________________________________County____________________________Zip Code________________ Premise Telephone number_____________________________________ Business e-mail address________________________________________ Is this location inside the city/village corporate limits: YES _______ NO __________ Mailing address (where you want to receive mail from the Commission) Name_______