Form 119 - Application For Liquor License Limited Partnership Insert - Form 2b - 2015
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2APPLICATION FOR LIQUOR LICENSE
Office Use
LIMITED PARTNERSHIP
INSERT – FORM 2b
NEBRASKA LIQUOR CONTROL COMMISSION
301 CENTENNIAL MALL SOUTH
PO BOX 95046
LINCOLN, NE 68509-5046
PHONE: (402) 471-2571
FAX: (402) 471-2814
Website:
All Partners, including spouses, are required to adhere to the following requirements
1) Must be a citizen of the United States
2) At least one (1) partner must be a Nebraska resident (Chapter 2 – 006)
3) Must provide a copy of their certified birth certificate or INS papers, or US Passport
4) Fingerprints are required. See Form 147 for further information, this form MUST be included
with your application
5) Must sign the signature page of the Application for License form
6) Primary Partner may be required to take a training course
Name of Primary Partner:
Last Name:__________________________________________________________________________
First Name:______________________________________________________ MI:_________________
Home Address:_________________________________________ City:__________________________
Social Security Number:_____________________________ Date of Birth:_______________________
Home Telephone Number:______________________________________________________________
Driver’s License Number: _______________________________________ State:___________________
Are you married? (Please call the NLCC office for special circumstances such as separations, etc)
YES
NO
If yes, provide your spouse’s information below
Spouses Last Name: ___________________________________________________________________
Spouses First Name:______________________________________________ MI:_________________
Social Security Number:_____________________________ Date of Birth:_______________________
Driver’s License Number: _______________________________________ State:___________________
Form 119
REV APR 2015
Page 1
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