Application For Liquor License Individual Insert-Form 1 (Shipper License)
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Application For Liquor License Individual Insert-Form 1 (Shipper License) Form. This is a Nebraska form and can be use in Liquor Control Commission Statewide.
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Tags: Application For Liquor License Individual Insert-Form 1 (Shipper License), 35-4182shpr, Nebraska Statewide, Liquor Control Commission
APPLICATION FOR LIQUOR LICENSE
INDIVIDUAL INSERT – FORM 1
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.ne.gov
SHIPPER LICENSE
Name of Applicant:
Last Name_______________________________________________________________
First Name__________________________________________ MI _________________
Home Address___________________________________City_____________State____
Home Telephone Number___________________________________________________
Social Security Number_______________________Date of Birth___________________
FORM 35-4182-ship
REV. 2/05
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