Form Taa-50g - Temporary Agency Agreement For County/city Lottery Licenses

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FORM

Temporary Agency Agreement for County/City Lottery Licenses

TAA-50G

• For Charitable Gaming Division use only

RESET FORM

• Read instructions on reverse side

SECTION I - County, City, or Village Information

1 County, City, or Village Name as Shown on Form 50G

2 Nebraska Identiﬁcation Number of the County, City, or Village

SECTION II - Charitable Gaming License Information

3 Type of County/City License:

Lottery Operator

Sales Outlet Location

4 Current License Holder’s Name and Address (Seller/Licensee)

5 Proposed License Holder’s Name and Address (Buyer/License Applicant)

Name

Business or Trade Name (if applicable)

Location Address

City

State

Zip Code

City

State

Zip Code

Nebraska Identiﬁcation Number

Liquor License Number (if applicable)

Nebraska Identiﬁcation Number

Liquor License Number (if applicable)

SECTION III - Temporary Agency Agreement

6 On ______________, _____, Seller and Buyer entered into a contract for sale of the business, currently known as ___________________________________,

which contract may be contingent upon Buyer receiving approval for the county/city lottery license to operate the business.

7 Seller will maintain a possessory interest in the property in the form of a lease, use permit, or license.

8 Buyer will at all times be the agent of the Seller, but Buyer will be completely and totally responsible for the operation of the business and for all liability

associated with the operation of the business during the time when Buyer is acting as Seller’s agent. It is speciﬁcally understood that Seller shall have no

liability for the operation of the business during this period of time, and Buyer agrees to indemnify and hold Seller harmless from any claims arising during

this period of operation; however, it is understood that the county/city lottery license remains in the name of the Seller and the Seller will be responsible for all

violations of the county/city lottery laws of the State of Nebraska until such time as Seller’s license is canceled.

9 At time of closing, certain funds will be held in escrow pending issuance of the license.

10 Financial institution where escrow account is being held:

Name

Address

Account Number

SECTION IV(A) - Agreement for a Lottery Operator License [Sales outlet locations, see Section IV(B)]

11 Seller and Buyer agree to allow Buyer to operate the lottery operator business, subject to approval by Charitable Gaming, for a period not to exceed the shorter of

(1) the expiration of the Seller’s lottery operator’s license or (2) 180 days subsequent to the date of ﬁling the Nebraska Schedule I with Charitable Gaming.

12 All proﬁts derived from the operation of the county/city lottery by the buyer, after required payments of prizes, salaries, and percentages to county, city, or

village, shall be paid to the escrow agent to be held until the issuance of the license, it being speciﬁcally understood that Buyer shall receive no proﬁts from

the operation of the business until the county/city lottery operator license has been issued to Buyer, but shall have the right to direct the investment of proﬁts

by the escrow agent.

13 Nothing herein shall be construed to limit or modify the terms and conditions of the Lottery Operator Agreement dated ________________, ________ by

and between Sponsoring Community and Lottery Operator/Seller, a copy of which is on ﬁle with Sponsoring Community and Charitable Gaming Division.

Seller shall continue to have all duties and obligations in regard to the Lottery Operator Agreement during the term of the Temporary Agency Agreement for

County/City Lottery Licenses.

SECTION IV(B) - Agreement for a Sales Outlet Location License [Lottery operators, see Section IV(A)]

14 Seller and Buyer agree to allow Buyer to operate the sales outlet location business, subject to approval by Charitable Gaming, for a period not to exceed 120

days subsequent to the date of ﬁling the Nebraska Schedule II with Charitable Gaming.

15 All commissions retained by or remitted to the sales outlet location due to the operation of the county/city lottery by Buyer, after any required payments of

expenses such as keno writer salaries, shall be paid to the escrow agent to be held until the issuance of the license, it being speciﬁcally understood that Buyer

shall receive no proﬁts from the operation of the business until the county/city lottery sales outlet location license has been issued to Buyer, but shall have the

right to direct the investment of proﬁts by the escrow agent.

16 Nothing herein shall be construed to limit or modify terms and conditions of the Site Agreement dated _________________, _______ by and between Lottery

Operator or Sponsoring Community and Sales Outlet Location/Seller, a copy of which is on ﬁle with Lottery Operator or Sponsoring Community and Charitable

Gaming Division. Seller shall continue to have all duties and obligations in regard to the Site Agreement during the term of the Temporary Agency Agreement

for County/City Lottery Licenses.

SECTION V - Understanding and Signatures

17 This agreement constitutes the entire and complete understanding of all parties with regard to the agency relationship and is binding upon the heirs, personal

representatives, and successors of the parties.

18 It is hereby understood that in the event Charitable Gaming denies the license application, this Temporary Agency Agreement is null and void on the date of the denial.

If signed by a corporate ofﬁcer, partner, member, LLC manager, or ﬁduciary on behalf of the licensee/license applicant, I hereby

certify that I have the authority to execute this Temporary Agency Agreement for County/City Lottery License.

sign

here

Signature of Seller

Title, If Applicable

Date

Signature of Buyer

Title, If Applicable

Date

Mail to: NEBRASKA DEPARTMENT OF REVENUE, CHARITABLE GAMING DIVISION, P.O. BOX 94855, LINCOLN, NE 68509-4855

FOR NEBRASKA DEPARTMENT OF REVENUE APPROVAL