REQUEST TO FILE CITIZEN PROTEST AGAINST NEW APPLICATION NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH, 5TH FLOOR PO BOX 95046 LINCOLN, NE 68509-5046 PHONE: (402) 471-2571 FAX: (402) 471-2814 Website: www.lcc.nebraska.gov �53-133 within ten days after receipt of a recommendation from the city, village, or county, or, if no recommendation is received, within forty-five days after the date of receipt of such application by the city, village, county clerk, objections in writing by not less than three persons residing within such city, village, or county, protesting the issuance of the license. Withdrawal of the protest does not prohibit the commission from conducting a hearing based upon the protest as originally filed and making an independent finding as to whether the license should or should not be issued; TYPE OR PRINT LEGIBALY NAME OF PROTESTANT: ___________________________________________________________ ADDRESS OF PROTESTANT: ________________________________________________________ ____________________________________________________________________________________ (include city & zip code) E-MAIL OF PROTESTANT:______________________________________________________________________ I consent to receive notice of hearing solely via electronic delivery at the e-mail address provided above (do not check this box if you wish to receive notice by mail). NAME OF APPLICANT FOR LIQUOR LICENSE: ___________________________________________________________________________________ ADDRESS OF APPLICANT: __________________________________________________________ ____________________________________________________________________________________ (include city & zip code) BARCODE PAGE 1 of 2 FORM 146 REV JUNE 2015 American LegalNet, Inc. www.FormsWorkFlow.com REASON(S) FOR PROTEST: __________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Notice indicating the time and place of such hearing shall be mailed or electronically delivered to the applicant, the local governing body, each individual protesting a license. If after hearing the license is approved costs for the hearing will be assessed against the protestants. Upon receipt of citizen's protest by the Commission it will be deemed public information and may be released upon request. I affirm that I'm a resident of the city or county for which application is being applied for; that I have read the foregoing with respect to notice and hearing, costs, and the availability of this information to the public; and I wish to protest the issuance of the applicant listed above. ______________________________________________________________________________ Signature of Protestant PAGE 2 of 2 FORM 146 REV JUNE 2015 American LegalNet, Inc. www.FormsWorkFlow.com