F ORM 7121 REV NOV 2018 REQUEST SIGNS AND POSTE RS 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 braska .gov Please complete the following and return to our office at the above address or fax number. You may also email to: lcc.frontdesk@nebraska.gov License # Trade n ame : Contact em ail a ddress: Mail to Address: Name: Address : City: State: Zip Code: Warning to Persons Under 21 Engli sh Spanish Required by Nebraska revised statute 53 - 180.04 Warning to Pregnant Women Sign English Spanish Required by Nebraska revised statute 53 - 148.01 Acceptable form of ID Poster English Spanish Warning to Intoxicated Person Poster English Spanish No Alcohol Beyond this Point Poster English Spanish Minor Identification Register (Black Book) English Spanish Wholesaler Information & Guidelines English Spanish Office Use only Date Stamp HERE ONLY American LegalNet, Inc. www.FormsWorkFlow.com