Corporation-LCC Application For License-Form 3
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Corporation-LCC Application For License-Form 3 Form. This is a Nebraska form and can be use in Liquor Control Commission Statewide.
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Tags: Corporation-LCC Application For License-Form 3, Nebraska Statewide, Liquor Control Commission
Corporation/LLC Application for License - Form 3
Nebraska Liquor Control Commission
PO Box 95046
301 Centennial Mall South
Lincoln NE 68509
SHIPPER APPLICANT
Total Number of Shares (if corporation)
Name of Corporation That Will Hold License
Corporate Street Address (1)
Corporate Telephone
Number
Mailing address for receipt of
Liquor Control Commission Mailings
City
State
Zip Code
IN THIS SECTION LIST THE NAME OF THE CHIEF EXECUTIVE OFFICER
Name
Title
Date of Birth
Social Security Number
Home Address (1)
City
State
Zip Code
Home Telephone Number
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Corporation/LLC Application for License - Form 3
PRINCIPLE OFFICERS, DIRECTORS, STOCKHOLDERS, MEMBERS AND SPOUSES
Name of Officers, Directors, Members and Spouses. Give Last Name, First
Name, Middle, Maiden, and any aliases
Social Security Number
Date of Birth
Title
Number of
Shares/ %
NAME
Spouse Name
NAME
Spouse Name
NAME
Spouse Name
NAME
Spouse Name
NAME
Spouse Name
NAME
Spouse Name
(If Necessary, Continue on Separate Sheet)
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