REQUEST FOR HARDSHIP STATUS 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/ OFFICE USE ONLY Rule 6-020.04 "Where a license has been issued and the licensee finds that the licensee will not be able to maintain continuous operation during the license year as a result of fire, tornado, flood, loss of lease or some other reason constituting a hardship the licensee shall apply to the Commission within thirty days of the occurrence constituting hardship for permission to voluntarily cease operations and maintain the licensee's license for a period of time not to exceed the end of the licensed year for which the license was issued." *In the event that the circumstances of hardship would continue past the license expiration date, a license renewal a new hardship status request is required. LIQUOR LICENSE #_________________________________CLASS TYPE________________________ LICENSEE NAME_______________________________________________________________________ TRADE NAME__________________________________________________________________________ PREMISE ADDRESS_____________________________________________________________________ CITY___________________________________________________________________________________ CONTACT PERSON_____________________________________________________________________ PHONE NUMBER OF CONTACT PERSON_________________________________________________ EMAIL ADDRESS OF CONTACT PERSON_________________________________________________ BARCODE LABEL FORM 145 REV 1/2014 Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com 1. REASON for request to place liquor license in hardship status: __________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 2. WHEN do you plan to reopen for business: _____________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ Note: If the building has be damaged enough to require a rebuild a reconstruction application must be filed with the Commission. You may not reopen until this application has been approved. Form 113 can be found at this link: http://www.lcc.nebraska.gov/LicensingForms/113-reconstruction.pdf 3. WHAT is the status of the alcohol? _______________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ 4. If any alcohol is to be stored off the licensed premises during the hardship period where will the alcohol be securely stored? (the off premise storage must be approved by the NLCC and is subject to inspection by law enforcement.) ____________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Office Use Only Reviewed by: ______________________________________ Approved Denied Blue Agenda Comments: ________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ FORM 145 REV 1/2014 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com