APPLICATION FOR LIQUOR LICENSE MICRODISTILLERY CHECKLIST NEBRASKA LIQUOR CONTROLCOMMISSION 301 CENTENNIAL MALL SOUTH PO BOX 95046 LINCOLN, NE 68509-5046 PHONE: (402) 471-2571 FAX: (402) 471-2814 Website: www.lcc.nebraska.gov Hot List Yes / No Class Type New Replacing #: License Number Initials Applicant Name __________________________________________________________________________________ Trade 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. You must first have made application with Alcohol and Tobacco Tax and Trade Bureau (TTB). REQUIRED ATTACHMENTS Microdistillery means a distillery located in Nebraska that is licensed to distill liquor on the premises of the distillery licensee and produces ten thousand or fewer gallons of liquor annually. _____ 1) Application fee $400 plus licensee fee $250 Total $650 (Check made payable to Nebraska Liquor Control Commission) or pay online at PAYPORT _____ 2) Copy of Federal Basic Permit application as filed with 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) OFFICE USE ONLY PAYMENT TYPE:_______________________________ AMOUNT:_____________________________________ RECEIVED BY:_________________________________ RECEIPT #:____________________________________ BARCODE American LegalNet, Inc. www.FormsWorkFlow.com FORM 130 REV APRIL 2016 PAGE 1 _____ 4) Submit diagram to include: a. Facility dimensions and description b. Identify production area c. Any storage area _____ 5) Copy of your detailed business plan _____ 6) Fingerprints are required for each person as defined in new application guideline. See FORM 147 for further information, this form MUST be included with your application _____ 7) Enclose the appropriate application forms Individual License (requires insert 1- FORM 104) Partnership License (requires insert 2 ­ FORM 105) Corporate License (requires insert 3A ­ FORM 101 & 3C FORM 103) Limited Liability Company (LLC) (requires insert 3B ­ FORM 102 & 3C FORM 103) _____ 8) If building is being leased send a copy of signed lease. Be sure the lease reads in the name of the individual(s), corporation or Limited Liability Company making application. Lease term must run through the license year being applied for. _____ 9) Corporation or Limited Liability Company must enclose a copy of articles of incorporation; as filed with the Secretary of State's Office. 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 American LegalNet, Inc. www.FormsWorkFlow.com FORM 130 REV APRIL 2016 PAGE 2 APPLICATION FOR LIQUOR LICENSE MICRODISTILLERY 301 CENTENNIAL MALL SOUTH 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 Z Microdistillery Application fee $400 plus licensee fee $250 Total $650 (Check made payable to Nebraska Liquor Control Commission) Class K Catering license (requires catering application FORM 106) $100.00 Copy of application filed with TTB for Federal Basic Permit Alcoholic Liquor Tax Bond minimum of $1,000 FORM 115 Additional fees may be assessed at city/village or county level when license is issued Term of license runs from May 1 ­ April 30 CHECK TYPE OF LICENSE FOR WHICH YOU ARE APPLYING Individual License (requires insert 1- FORM 104 Partnership License (requires insert 2 ­ FORM 105) Corporate License (requires insert 3A ­ FORM 101 & 3C FORM 103) Limited Liability Company (LLC) (requires insert 3B ­ FORM 102 & 3C FORM 103) 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 130 REV APRIL 2016 PAGE 3 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: Mailing address (where you want to receive mail from the Commission) Name_________________________________________________________________________________________ Street Address #1________________________________________________________________________________ Street Address #2________________________________________________________________________________ City______________