Form 50g - Schedule Iii - Nebraska Schedule Iii County/city Lottery Worker Application Page 2
Download a blank fillable Form 50g - Schedule Iii - Nebraska Schedule Iii County/city Lottery Worker Application in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form 50g - Schedule Iii - Nebraska Schedule Iii County/city Lottery Worker Application with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2iNstrUctioNs
WHO MUST FILE. Any individual who intends to perform any work directly
sPeciFic iNstrUctioNs
related to the conduct of a county/city lottery must complete and file this
LINE 1. NEBRASKA IDENTIFICATION NUMBER. Enter the state
application. A county/city lottery worker license applicant must be at least
identification number assigned to the county, city, or village. This number
19 years of age. Work directly related to the conduct of a lottery means any
is found on every county/city lottery license issued by the Department and
work involving the actual day-to-day conduct of the lottery, including, but
is identified as 35-xxxxxxx. If this number is unknown or not assigned, this
not limited to, ticket writing, working as a keno runner, winning number
space may be left blank.
selection, prize payments to winners, record keeping, shift checkout, review
of keno writer banks, security, and compiling or filing county/city lottery
LINE 2. COUNTY, CITY, OR VILLAGE NAME. Enter the name of the
tax return information. Please refer to Regulation 35-619 of the County and
county, city, or village for whom the applicant will be working. This information
City Lottery Regulations for a detailed description of individuals who are
is found on the license displayed at the location of the lottery or on the Nebraska
required to file this application.
Application for County/City Lottery, Form 50G. List only the county, city, or
WHEN AND WHERE TO FILE. A properly completed and signed
village on the license. If the lottery is conducted jointly with another county,
city, or village, file one Schedule III and indicate the name of each county,
application must be filed with the Nebraska Department of Revenue
(Department) prior to a lottery worker beginning his or her duties.
city, or village involved.
The application will be considered on file with the Department once the
LINE 5. A new application is required for each new lottery worker and
Nebraska Schedule III has been received by the Department, or as of the
anyone who has terminated employment or is currently inactive, but wishes
date postmarked or electronically transmitted to the Department, provided
to resume work at a later date. If reporting changes to a previously-filed
the application is received by the Department within 10 days after the date
license application, check the “report changes” box. Check the “inactive”
postmarked or electronically transmitted. An application not received within
box when an individual is no longer actively working with a county/city
10 days of the date postmarked or electronically transmitted is not considered
lottery. The “cancel” box is to be marked only by a lottery worker to request
filed. The applicant must cease performing any duties for the lottery until the
cancellation of his or her license. The “cancel” box may not be used by a
Nebraska Schedule III is on file with the Department. A separate Nebraska
county, city, village, or lottery operator to report that an individual is no
Schedule III must be submitted for each county, city, or village for which
longer working for the county, city, village, or lottery operator.
the applicant will be performing duties related to the conduct of the lottery.
Incomplete applications will be returned to the county, city, or village and the
LINES 6, 6a, AND 6b. FINGERPRINTING REQUIREMENTS. If a box
lottery worker license applicant must immediately cease working with the
in the left-hand column is marked and the applicant answered “No” to lines
lottery until a properly completed application is on file with the Department.
6a and 6b, two fingerprint cards and the proper fees must be submitted to the
In order to determine whether a license application has been filed with the
Nebraska State Patrol for criminal background investigation purposes. To obtain
Department, contact our office by telephone or visit
fingerprint cards and instructions for their completion, contact the Charitable
gaming. In order to access the lottery worker database on the Web site, the
Gaming Division at the address or telephone number listed below.
User Name and Password are needed. Only county/city lottery licensees,
governing officials, and their designated authorized representatives may
LINES 7 AND 8. If the “Yes” box is checked, provide an attachment with
access the lottery worker database. The User Name and Password may be
the following information, if known:
obtained by contacting our office.
1.
The date and place the incident occurred;
All lottery worker licenses expire on May 31 of odd-numbered years, and may
2.
The court case or docket number under which it is filed’
be renewed biennially. All applications for license renewal must be submitted
at least 60 days prior to the expiration date of the license.
3.
The original charge and ultimate disposition of the matter; and
The Nebraska Schedule III may also be utilized after an initial filing to report
4.
A description of the events which are the subject of the incident.
changes in the application information, or to report that the license is inactive
or void. If a lottery worker is no longer working with a county/city lottery, the
LINE 9. For purposes of complying with Neb. Rev. Stat. §§ 4-108 through
Department must be notified by marking inactive on a Schedule III and filing
4-114, all new lottery worker license applicants are required to complete
the form with our office. Any changes in the information originally submitted
this section. This information will be used by the Department to verify the
on the application form must be promptly reported to the Department. These
license applicant’s lawful presence in the United States. A license application
changes are also to be reported to the county, city, or village.
will be denied if the information provided is false.
Each applicant should review the questions on the application carefully
LINE 10. Enter the state identification number and name of the lottery
and provide accurate responses. If any of the information provided by the
operator.
applicant is found to be false, the applicant will be disqualified and a notice
of disqualification and intended license application denial may be issued.
LINE 11. Enter the state identification number and name of each lottery
Disqualified workers may not work for a county/city lottery at any time. If
sales outlet location only if the applicant performs work at the sales outlet
location’s place of business. If a state identification number has not yet been
the responses of a licensed lottery worker reporting changes are found to be
false, notice of license suspension, cancellation, or revocation, as applicable,
assigned, this space may be left blank. Enter only one sales outlet location
may be issued.
per line. If additional space is needed, attach a separate sheet listing the
additional locations.
There are three methods that can be used to file the Nebraska Schedule III.
AUTHORIZED SIGNATURES. The application must be signed by
(1) Mail the Nebraska Schedule III and any attachments to the Nebraska
Department of Revenue, Charitable Gaming Division, P.O. Box 94855,
the applicant and by a governing official or their designated, authorized
Lincoln, Nebraska 68509-4855. (2) Transmit the Nebraska Schedule III and
representative to be valid.
any attachments electronically to (402) 471-5600 and mail the original. (3)
Personally deliver the Nebraska Schedule III to any of the Department’s offices
Any questions regarding the completion of this application should be addressed
to the Nebraska Department of Revenue, Charitable Gaming Division, P.O.
in Grand Island, Lincoln, Norfolk, North Platte, Omaha, or Scottsbluff. Original
Box 94855, Lincoln, Nebraska 68509-4855, telephone (402) 471-5937 or toll
signatures are required in order to process the application. Make a copy of the
free at (877) 564-1315. Additional information and forms may be obtained at
Nebraska Schedule III for your records and provide a copy to the county, city
gaming.
or village listed at the top of the form.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial