Form 101 - Application For Liquor License Corporation Insert - Form 3a - 2015 Page 4
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4Is the applying corporation controlled by another corporation/company?
YES
NO
If yes, provide the following:
1)
Name of corporation ____________________________________________________________
2)
Supply an organizational chart of the controlling corporation named above
3)
Controlling corporation MUST be registered with the Nebraska Secretary of State, copy of articles must
be submitted with application §53-126
Indicate the Corporation’s tax year with the IRS (Example January through December)
Starting Date:_____________________________ Ending Date:_______________________________
Is this a Non-Profit Corporation?
YES
NO
If yes, provide the Federal ID # __________________________________________________________
In compliance with the ADA, this corporation insert form 3a is available in other formats for persons with disabilities.
A ten day advance period is requested in writing to produce the alternate format.
FORM 101
REV JUNE 2015
Page 4 of 4
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Parent category: Business