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NEBRASKA LIQUOR CONTROL COMMISSION <br /> 301 CENTENNIAL MALL SOUTH <br /> PO BOX 95046 <br /> LINCOLN,NE 68509-5046 <br /> PHONE.(402)471-2571 <br /> FAX (402)471-2814 <br /> Website: wwwlccnebraskaeov <br /> Special Designated License <br /> Local Recommendation Form <br /> Nebraska Craft Brewers Guild <br /> Retail Liquor License Name or Non-Profit Organization <br /> 1023 Lincoln Mall STE 103 Lincoln, NE 68508 <br /> Retail Liquor License Address or Non-Profit Business Address <br /> 91-1838176 <br /> Retail License Number or Non-Profit Federal ID # (Form #201 must be submitted as attachment) <br /> Event Date(s): 9-11-18 9-12-18 94348 <br /> Event Time(s): 9 AM-7 PM 9 AM-7 PM 9 AM-7 PM <br /> Alternate Date: <br /> Alternate Location Building & Address: <br /> Event Building Name: Outdoor Beer Garden Husker Harvest <br /> Days <br /> Event Street Address/City: 9000 West Husker Highway, Wood River, NE <br /> 68883 <br /> Indoor area to be licensed in length &width: X <br /> Outdoor area to be licensed in length & width: 75 X 66 (Diagram Form #109 must be attached) <br /> Type of Event: Outdoor Farm Show Estimate#of attendees: 3'000 <br /> Type of alcohol to be served: Beer X Wine Distilled Spirits <br /> (If not marked,you will not be able to serve this type of alcohol) <br /> Event Contact Name: Matt JUngmann <br /> (Please print) <br /> Event Contact Phone Number: 309-371-6117 <br /> Event Contact Email: matt.jungmann @farmprogress.com <br /> Local Governin2 Body completes below: <br /> The local governing body for the City or County approves the issuance of a Special <br /> Designa icense as • . . - :• above. <br /> —r _ _ 7//D /8t <br /> ocal Governin_ : is -Authorized Signature Date <br /> FORM 200 <br /> REV NOV 2016 <br />