Pickle Card 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.
Class I Pickle
Form Title | Type | Form # | Document |
|---|---|---|---|
Checklist (Make Sure Your Application is Complete) | Applications | ||
Nebraska Application for Bingo, Lottery, or Lottery by Pickle Card | Applications | 50 | |
Nebraska Application for Utilization of Funds Member | Applications | 50H | |
Nebraska Registration and Report of Pickle Card Dispensing Devices | Applications | 50F | |
Nebraska Lottery by Pickle Card Annual Report | Reporting | 35A |
Class II Pickle
Form Title | Type | Form # | Document |
|---|---|---|---|
Checklist (Make Sure Your Application is Complete) | Applications | ||
Instructions for Completion of BIENNIAL License Renewal Application | Applications | ||
Nebraska Application for Bingo, Lottery, or Lottery by Pickle Card | Applications | 50 | |
Schedule II, Authorization for Pickle Card Operators Application | Applications | 50, Sch. II | |
Nebraska Application for Utilization of Funds Member | Applications | 50H | |
Nebraska Application for Pickle Card Sales Agent | Applications | 50E | |
Instructions for Completing Fingerprint Application | Applications | ||
Background Check Waiver | Applications | ||
Nebraska Registration and Report of Pickle Card Dispensing Devices | Applications | 50F | |
Nebraska Lottery by Pickle Card Annual Report - View and Print Only | Reporting | 35A | |
Nebraska Pickle Card Sales Invoice and Receipt Reorder Form | Reporting |
Pickle Card Operators
Manufacturers and Distributors
Form Title | Form # | Document |
|---|---|---|
Nebraska Application for Manufacturers, Distributors, and Manufacturer-Distributors | 50A | |
Nebraska Distributor of Pickle Cards Tax Return | 51A | |
Schedule I, Distributor Activity Report | 51A, Sch. I | |
Personal History Record and Background Disclosure Form for Charitable Gaming Licensees and Nebraska (State) Lottery Vendors | ||
A Summary of Your Rights Under the Fair Credit Reporting Act | ||
Affidavit by Spouse for Waiver of Fingerprinting and/or Personal History Record and Background Disclosure Form for Charitable Gaming Licensees | ||
Instructions for Completing Fingerprint Application | ||
Background Check Waiver | ||
Nebraska Licensed Manufacturers | ||
Nebraska Licensed Distributors |
