FORM 35-7080 NEBRASKA LIQUOR CONTROL COMMISSION SPIRIT AND WINE MONTHLYREV MAY 2015 REPORT Shipper Name Doing Business As No Shipments This Month Nebraska Wholesaler Shipped to: Shipper License # Reporting Month / Year (mm/yyyy) I Certify that the below information is correct Name of person completing this form Contact Phone # Contact Email Address Date Submitted NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH PO BOX 95046 LINCOLN NE 68509-5046 TELEPHONE 402-471-2571 FAX 402-471-2814 Website: www.lcc.nebraska.gov INVOICE DATE SHIPMENT DATE INVOICE # SPIRIT GALLONS WINE GALLONS American LegalNet, Inc. www.FormsWorkFlow.com FORM 35-7080 NEBRASKA LIQUOR CONTROL COMMISSION SPIRIT AND WINE MONTHLYREV MAY 2015 REPORT Shipper Name Doing Business As No Shipments This Month Nebraska Wholesaler Shipped to: Shipper License # Reporting Month / Year (mm/yyyy) I Certify that the below information is correct Name of person completing this form Contact Phone # Contact Email Address Date Submitted NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH PO BOX 95046 LINCOLN NE 68509-5046 TELEPHONE 402-471-2571 FAX 402-471-2814 Website: www.lcc.nebraska.gov INVOICE DATE SHIPMENT DATE INVOICE # SPIRIT GALLONS WINE GALLONS American LegalNet, Inc. www.FormsWorkFlow.com