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APPLICATION FOR LIQUOR LICENSE <br /> CHECKLIST-RETAIL RECEIVED <br /> NEBRASKA LIQUOR CONTROL COMMISSION <br /> 301 CENTENNIAL MALL SOUTH JUL 1 6 2018 <br /> PO BOX 95046 <br /> LINCOLN,NE 68509-5046 <br /> PHONE:(402)471-2571 <br /> FAX:(402)471-2814 N ASKA LIQUOR <br /> %Suite:www.letntukagov C NT OLeti501 AISSION <br /> Hot List: YES/NO New eplacing# <br /> Chas Type 122642 Initial y! <br /> Applicant n a m e /r9 i Ch a 2,/ Frei n"Z 1,1. e c k <br /> Trade name FO /U&JP�L. U.t <)eV ( to sea- <br /> Previous trade name PO P.&- U t Q 1/ NC" efi-e_cAs i <br /> Contact email address ID i e r ks tro j e &m Q;J. C tam <br /> Provide all the items requested. Failure to provide any item will cause this application to be returned or placed on <br /> hold. All documents must be legible. Any false statement or omission may result in the denial, suspension, <br /> cancellation or revocation of your license. If your operation depends on receiving a liquor license, the Nebraska <br /> Liquor Control Commission cautions you that if you purchase, remodel, start construction, spend or commit money <br /> that you do so at your own risk. Prior to submitting your application review the application carefully to ensure that <br /> all sections are complete, and that any omissions or errors have not been made. You may want to check with the <br /> city/village or county clerk, where you are making application, to see if any additional requirements must be met <br /> before submitting application to the Nebraska Liquor Control Commission. <br /> I1-ea DATE !—l` ika `E No. 169576 <br /> FROM [ \ \c tna,e I vJ ∎-ect <br /> a <br /> II FOR ��- 7t Lk , 7). <br /> V "I'=` ❑CASH SS <br /> • 2.0 3c <br /> _ J c i CHECK <br /> ❑ MONEY/ <br /> ORDER <br /> Rewl�Ytr1' '.k, <br /> 71( 4 - MSC <br /> Office u.e only J / 7 <br /> PAYMAMO NT: /✓7" i �"�f _. II 1.1 JHiIfli I <br /> Rc / o g 7 1p Received:_(, _ 18000088 <br /> v FORM 100 <br /> 2 TaEV MAY 2015 <br /> Dj �..i i (1, PACE 1 <br /> :. 1: #.464., LJ <br />