County/City Lottery (Keno) Forms
Printing Instructions
Most of these forms are available in a "Fill-able" format, meaning you can view, complete, and print the form on your computer. These forms use the features provided with Adobe Acrobat. Currently, there is no validation or verification of the information you enter, and you are responsible for entering and checking all required information. Instructions may require some information to be handwritten on the form (signatures, for example).
Note: The Acrobat Reader does not allow you to save your completed forms. You should print two copies -- one to mail, and one to keep for your records.
Applications
| Form Title | Form # | Document |
|---|---|---|
| Licensing Checklist |  Form |
|
| Nebraska Application for County/City Lottery | 50G | Form |
| Schedule I, County/City Lottery Operator Application | 50G, Sch. I | Form |
| Schedule II, County/City Lottery Sales Outlet Location Application | 50G, Sch. II | Form |
| Schedule III, County/City Lottery Worker Application | 50G, Sch. III | Form |
| Nebraska Application for Manufacturers, Distributors, and Manufacturer-Distributors | 50A | Form |
| Instructions for Completing Fingerprint Application | Form |
|
| Background Check Waiver | Form |
Miscellaneous
|
Form Title |
Form # |
Document |
|---|---|---|
|
Request for Abatement of Penalty |
21 |
|
|
Power of Attorney |
33 |
|
|
Temporary Agency Agreement (TAA) for County/City Lottery Licenses |
TAA-50G |
|
|
Personal History Record and Background Disclosure Form for Charitable Gaming Licensees and Nebraska (State) Lottery Vendors |
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|
A Summary of Your Rights Under the Fair Credit Reporting Act |
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|
Affidavit by Spouse for Waiver of Fingerprinting and/or Personal History Record and Background Disclosure Form for Charitable Gaming Licensees |
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|
Nebraska Licensed Manufacturers |
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Nebraska Licensed Distributors |
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Nebraska Licensed Manufacturer-Distributors of Lottery Supplies and Equipment |
