Form 110 - Application For Addition To Liquor License -2015

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APPLICATION FOR ADDITION
Office Use
TO LIQUOR LICENSE
NEBRASKA LIQUOR CONTROL COMMISSION
301 CENTENNIAL MALL SOUTH
PO BOX 95046
LINCOLN, NE 68509-5046
PHONE: (402) 471-2571
FAX: (402) 471-2814
Website:
Application:
 Must include processing fee of $45.00 check made payable to the Nebraska Liquor Control
Commission or you may pay online at
 Must include a copy of the lease or deed showing ownership of area to be added. This is still
required even if it’s the same as on file with original application
 Must include simple hand drawn sketch showing existing licensed area and area to be added,
must include outside dimensions in feet (not square feet), show direction north.
NO BLUE PRINTS
 May include approval from the local governing body; no addition shall be approved unless
endorsed by the local governing body
 Check with your local governing body for any additional requirements that may be necessary in
making this request for addition
LIQUOR LICENSE #__________________________________CLASS TYPE________________________
LICENSEE NAME________________________________________________________________________
TRADE NAME___________________________________________________________________________
PREMISE ADDRESS______________________________________________________________________
CITY_________________________ZIP CODE_______________COUNTY_________________________
CONTACT PERSON______________________________________________________________________
PHONE NUMBER OF CONTACT PERSON__________________________________________________
EMAIL ADDRESS OF CONTACT PERSON__________________________________________________
BARCODE
LABEL
FORM 110
REV JULY 2015
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