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The undersigned applicant(s)hereby consent(s)to an investigation of hislber background and release present and Mute records of every kind and <br /> description including police records,tax records(State and Federal),and bank or lending institution records,and said appliant(s)and spouse(s)waive(s) <br /> any right or causes of action that said applicant(s)or spouse(s)may have against the Nebraska Liquor Control Commission,the Nebraska State Patrol,and <br /> any other individual disclosing or releasing said information. Any documents or records for the proposed business or for any partner or stockholder that <br /> are needed in furtherance of the application investigation of any other investigation shall be supplied immediately upon demand to the Nebraska Liquor <br /> Control Commission or the Nebraska State Patrol. The undesiaoed widastnd and acknowledae ti.. any lice se issued bath on the infomu[ion <br /> ggbtmroed in this application.is subiect to cancellation if the information contained herein is incomplete.inaccurate or fraudulent,. <br /> Individual applicants agree to supervise in person the management and operation of the business and that they will operate the business authorized by the <br /> license for themselves and not as an agent for any other pawn or entity. Corporate applicants agree the approved manager will superintend in pawn the <br /> management and operation of the business. Partnership applicants agree one partner shall superintend the management and operation of the business. All <br /> applicants agree to operate the licensed business within all applicable laws,ruts,regulations,and ordinances and to cooperate fully with any authorized <br /> agent of the Nebraska Liquor Control Commission. <br /> Must be signed in the presence of a notary public by applicant(s) and spouse(s). See guideline for required signatures <br /> ktto://www.lcc.ne.gov/ndfs/New%2OApalication%2OGuidelinc.ndf <br /> 044a hital <br /> of Applicant Signature of Spouse <br /> '7;11 Eta n L 41 <br /> Print Name Print Name <br /> Signature of Applicant Signature of Spout <br /> Print Name Print Name <br /> ACKNOWLEDGEMENT <br /> State of Nebraska <br /> County of lie;C( The foregoing instrument was acknowledged before me this <br /> tQ 1 by j(1;("t ff.rz. W;eJ; <br /> date name of person(s)acknowledged(individual(s)signing) <br /> Notary Public signature <br /> A GEN&OW lltlidNowa <br /> A dflt.RUSIN.. <br /> Iy Carer EOp.OelObn 13,2021 <br /> le compliance with the ADA,this application is available in other formats for persons with disabilities. <br /> A tee day advance period is required in writing to produce the alternate forest. <br /> FORM 100 <br /> REV MAY 2015 <br /> PAGE 8 <br />