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

  

Form

Nebraska Application for Bingo, Lottery, or Lottery by Pickle Card

Applications

50

Form

Nebraska Application for Utilization of Funds Member

Applications

50H

Form

Nebraska Registration and Report of Pickle Card Dispensing Devices

Applications

50F

Form

Nebraska Lottery by Pickle Card Annual Report

Reporting

35A

Form

Class II Pickle

Form Title

Type

Form #

Document

Checklist (Make Sure Your Application is Complete)

Applications

  

Form

Instructions for Completion of BIENNIAL License Renewal Application

Applications

  

Form

Nebraska Application for Bingo, Lottery, or Lottery by Pickle Card

Applications

50

Form

Schedule II, Authorization for Pickle Card Operators Application

Applications

50, Sch. II

Form

Nebraska Application for Utilization of Funds Member

Applications

50H

Form

Nebraska Application for Pickle Card Sales Agent

Applications

50E

Form

Instructions for Completing Fingerprint Application

Applications

  

Form

Background Check Waiver

Applications

  

Form

Nebraska Registration and Report of Pickle Card Dispensing Devices

Applications

50F

Form

Nebraska Lottery by Pickle Card Annual Report - View and Print Only

Reporting

35A

Form

Nebraska Pickle Card Sales Invoice and Receipt Reorder Form

Reporting

  

Form

Pickle Card Operators

Form Title

Form #

Document

Schedule II, Authorization for Pickle Card Operators Application

50

Form

Nebraska Application for Pickle Card Operator

50D

Form

Nebraska Registration and Report of Pickle Card Dispensing Devices

50F

Form

Manufacturers and Distributors

Form Title

Form #

Document

Nebraska Application for Manufacturers, Distributors, and Manufacturer-Distributors

50A

Form

Nebraska Distributor of Pickle Cards Tax Return

51A

Form

Schedule I, Distributor Activity Report

51A, Sch. I

Form

Personal History Record and Background Disclosure Form for Charitable Gaming Licensees and Nebraska (State) Lottery Vendors

  

Form

A Summary of Your Rights Under the Fair Credit Reporting Act

  

Form

Affidavit by Spouse for Waiver of Fingerprinting and/or Personal History Record and Background Disclosure Form for Charitable Gaming Licensees

  

Form

Instructions for Completing Fingerprint Application

  

Form

Background Check Waiver

  

Form

Nebraska Licensed Manufacturers

  

Document

Nebraska Licensed Distributors

  

Document

Miscellaneous

Form Title

Form #

Document

Request for Abatement of Penalty

21

Form

Power of Attorney

33

Form

Reconciliation of Deposits to Sales

  

Form
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