CONTROLLING CORPORATION
Office Use
INSERT
NEBRASKA LIQUOR CONTROL COMMISSION
301 CENTENNIAL MALL SOUTH
PO BOX 95046
LINCOLN, NE 68509-5046
PHONE: (402) 471-2571
FAX: (402) 471-2814
Website:
Attach copy of Articles as filed with the Nebraska Secretary of State - §53-126
Name and address of the controlling corporation of the applying corporation
Controlling Corporation Name: _______________________________________________________________________
Controlling Corporation Address:______________________________________________________________________
City:_______________________________________ State:___________________ Zip Code:______________________
Provide the names of the top four officer/members of the controlling corporation
1. Full Name: _________________________________________________________________________________
Job Title: _______________________________________________________________________________
2. Full Name: _________________________________________________________________________________
Job Title: _______________________________________________________________________________
3. Full Name: _________________________________________________________________________________
Job Title: _______________________________________________________________________________
4. Full Name: _________________________________________________________________________________
Job Title: _______________________________________________________________________________
FORM 185
NOV 2015
Page 1