Form 50 - Nebraska Application For Bingo, Lottery, Raffle, Or Lottery By Pickle Card Page 3
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3Local Control. Any lottery or raffle licensee desiring to conduct a lottery or raffle within the boundaries of any Class 6 or 7
county (Douglas and Lancaster), or within the corporate limits of any metro politan or primary class city (Omaha and Lincoln),
may be required to receive specific authorization by ordinance or resolution of the city or county to conduct this activity. Please
check with your local city and county clerk regarding this requirement.
Before you conduct any bingo games, lotteries, raffles, or lottery by the sale of pickle cards, you must have physical
possession of the licenses issued by the Department.
Specific Instructions
Line 5. Type of License.
Bingo Class I — A Class I license is issued to an applicant whose gross receipts from the conduct of bingo will be less than
$100,000 per 12-month period beginning October 1 of each year or another date as the Department may prescribe by rule
and regulation.
Bingo Class II — A Class II license is issued to an applicant whose gross receipts from the conduct of bingo will be equal to or
greater than $100,000 per 12-month period beginning October 1 of each year or another date as the Department may prescribe
by rule and regulation. A Class II licensee must also license a gaming manager (see
Nebraska Application for Gaming Manager,
Form
50C).
Lottery by Pickle Card Class I — A Class I license is issued to an applicant wishing to sell pickle cards only at their designated
premises and at the location of their regularly-scheduled bingo occasions.
Lottery by Pickle Card Class II — A Class II license is issued to an applicant wishing to sell pickle cards at the premises of one
or more licensed pickle card opera tors. A Class II licensee must also license a sales agent (see
Nebraska Application for Sales
Agent, Form
50E). Class II licensees may also sell pickle cards at their designated premises and at the location of their regularly-
scheduled bingo occasions.
Lottery/Raffle Special Permit — A Lottery/Raffle licensee may apply for one special permit per 12-month period commencing
October 1 of each year. The special permit is valid for a maximum of three consecutive calendar months. If an organization
con ducts a special lottery and a special raffle, both activities must be conducted within the same three-month period.
Please Note: Utilization of Funds Member — Each applicant for a license to conduct bingo, pickle card, or lottery/raffle activities
must also submit a
Nebraska Application for Utilization of Funds Member, Form
50H, to license at least one member of the organization
as a utilization of funds member. A person may act as a utilitization of funds member for more than one charitable gaming activity of a
licensee, without applying for multiple licenses.
Line 6. Type of Application. If you are canceling a license, the original license issued by the Department must be returned. If you are
upgrading from a Class I to a Class II license, indicate in line 5 the type of license to be upgraded and provide the appropriate officer’s
signature. Remit the difference in the fee for the license currently held and the fee for the upgraded license.
Line 9. IRS Code Section. Indicate the specific subsection of IRC § 501 under which the applicant organization is exempt. Attach a
copy of the exemption determination letter issued by the IRS. If the applicant organization is exempt under a group ruling issued by
the IRS, indicate the Group Exemption Number. If the applicant organization is an agency or instrumentality, educational, charitable,
or religious institution operated, supervised, and controlled by the Roman Catholic Church, provide a copy of the page in the current
Official Catholic Directory where the applicant organization’s name appears. Exemption determination letters do not need to be included
with applications for renewal or when applying for additional licenses, unless specifically requested by the Charitable Gaming Division.
Line 10. Number of Members. Indicate the number of members of the applicant organization. A member is someone who has
qualified for and been admitted to membership in the applicant organization, for purposes other than conducting gaming activities,
pursuant to the bylaws, articles of incorporation, or other written statement of the applicant organization.
Line 12. Identify Separate Bank Accounts. Identify the separate bank accounts for bingo, lottery by the sale of pickle cards, and
lottery/raffle. If you are applying for more than one type of license, a separate account is required for each activity.
Line 13. Designated Premises. For pickle card licensees only, indicate a designated premises. A designated premises is one location
selected by an applicant organization, where pickle cards may be sold. The type of location which may be selected depends on the
subsection of IRC § 501(c) under which the applicant organization is exempt. See
Neb. Rev. Stat. §
9-306.01.
Line 14. Description of the Designated Premises. Provide a brief description of the building or portion of the building to be
selected as the designated premises. For example: 1810 West Tenth Street, east portion, approximately 50' x 100' of main floor of a
three-story building.
Line 15. Identify Officers. Identify the officers of the applicant organization. For each officer, provide Social Security number (optional),
name, address, date of birth, and title. The application must be signed by one of the officers listed in line 15. Persons who are not listed in
line 15 who have signed the application must attach a completed
Power of Attorney, Form
33.
Any questions regarding the completion of this application should be addressed to the Nebraska Department of Revenue,
Charitable Gaming Division, at 402-471-5937 or 877-564-1315.
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