FOR OFFICE USE ONLY PAID: Corp. & Trade Name Nebraska Liquor License # Address City, State, Zip Code Non-Licensee Licensee (Additional Copies, No Charge) Line 1 How many books? X $6.50 = $ Line 2 State Sales Tax $ Line 1 X $0.055 Line 3 City Sales Tax (if applicable) $ Line 1 X city rate below Line 4 TOTAL DUE $ Add lines 1, 2, and 3 x-noneAINSWORTHx-none0.015x-noneCLARKSONx-none0.015x-noneGORDONx-none0.01x-noneMCCOOKx-none0.015x-noneRED CLOUDx-none0.015x-noneALBIONx-none0.015x-noneCLAY CENTERx-none0.01x-noneGOTHENBURGx-none0.015x-noneMCCOOL JUNCTIONx-none0.015x-noneREPUBLICAN CITYx-none0.01x-noneALLIANCEx-none0.015x-noneCLEARWATERx-none0.015x-noneGRAND ISLANDx-none0.015x-noneMEADOW 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x-noneFRIENDx-none0.01x-noneLOUP CITYx-none0.015x-nonePLYMOUTHx-none0.015x-noneWEST POINTx-none0.015x-noneCHADRONx-none0.02x-noneFULLERTONx-none0.015x-noneLYONSx-none0.015x-nonePONCAx-none0.015x-noneWILBERx-none0.015x-noneCHAMBERSx-none0.01x-noneGENEVAx-none0.02x-noneMADISONx-none0.015x-noneRALSTONx-none0.015x-noneWISNERx-none0.02x-noneCHAPPELLx-none0.02x-noneGENOAx-none0.015x-noneMALCOLMx-none0.01x-noneRANDOLPHx-none0.02x-noneWOOD RIVERx-none0.015x-noneCHESTERx-none0.01x-noneGERINGx-none0.015x-noneMARQUETTEx-none0.015x-noneRAVENNAx-none0.015x-noneWYMOREx-none0.015x-noneCLARKSx-none0.01x-noneGIBBONx-none0.01x-noneMAYWOODx-none0.015x-noneYORKx-none0.02 x-noneP.O. BOX 95046 x-noneLINCOLN, NE 68509 x-noneDO NOT SEND CASH x-noneIf submitting this form via email, please send to nlcc.beerdesk@nebraska.gov x-noneIn compliance with ADA, this form is available in other formats for persons with disabilities.A ten day advance period is requested in writing to produce the alternate format. x-noneNEBRASKA LIQUOR CONTROL COMMISSION x-none2013 LAW BOOK ORDER FORM x-noneCITY SALES TAX TABLE x-noneEFFECTIVE 02/01/2019 x-nonePay by credit card or EFT through PayPort at www.ne.gov/go/NLCCpayport x-noneor make checks payable to: FORM 35-7120 American LegalNet, Inc. www.FormsWorkFlow.com