Form 147 Privacy Act Statement/ Submission of Fingerprints / Payment of Fees to Nsp-Cid - Nebraska

Form 147 is a Nebraska Liquor Control Commission form also known as the "Privacy Act Statement/ Submission Of Fingerprints / Payment Of Fees To Nsp-cid". The latest edition of the form was released in May 1, 2018 and is available for digital filing.

Download a PDF version of the Form 147 down below or find it on Nebraska Liquor Control Commission Forms website.

ADVERTISEMENT
PRIVACY ACT STATEMENT/
Office Use only
SUBMISSION OF FINGERPRINTS /
PAYMENT OF FEES TO NSP-CID
NEBRASKA LIQUOR CONTROL COMMISSION
301 CENTENNIAL MALL SOUTH
Date Stamp HERE ONLY
PO BOX 95046
LINCOLN, NE 68509-5046
PHONE: (402) 471-2571
FAX: (402) 471-2814
Website: www.lcc.nebraska.gov
THIS FORM IS REQUIRED TO BE SIGNED BY EACH PERSON BEING FINGERPRINTED
:
DIRECTIONS FOR SUBMITTING FINGERPRINTS AND FEE PAYMENTS:
 FAILURE TO FILE FINGERPRINT CARDS AND PAY THE REQUIRED FEE TO THE
NEBRASKA STATE PATROL WILL DELAY THE ISSUANCE OF YOUR LIQUOR LICENSE
 Fee payment of $45.25 per person MUST be made DIRECTLY to the Nebraska State Patrol;
It is recommended to make payment through the NSP PayPort online system at
www.ne.gov/go/nsp
Or a check made payable to NSP can be mailed directly to the following address:
***Please indicate on your payment who the payment is for (the name of the person being
fingerprinted) and the payment is for a Liquor License***
The Nebraska State Patrol – CID Division
th
3800 NW 12
Street
Lincoln, NE 68521
 Fingerprints taken at NSP LIVESCAN locations will be forwarded to NSP – CID
Applicant(s) will not have cards to include with license application.
 Fingerprints taken at local law enforcement offices may be released to the applicants;
Fingerprint cards should be submitted with the application.
Applicant Notification and Record Challenge: Your fingerprints will be used to check the criminal history
records of the FBI. You have the opportunity to complete or challenge the accuracy of the information
contained in FBI identification record. The procedures for obtaining a change, correction, or updating a
FBI identification record are set forth in Title 28, CFR, 16.34.
Trade Name:__________________________________________________________________
Name of Person Bring Fingerprinted:_______________________________________________
Date of Birth:__________ Last 4 SSN:______ Date fingerprints were taken:__________
Location where fingerprints were taken:_____________________________________________
How was payment made to NSP?
☐NSP PAYPORT ☐CASH ☐CHECK SENT TO NSP CK # __________
My fingerprints are already on file with the commission – fingerprints completed for a previous
application less than 2 years ago? YES ☐
SIGNATURE REQUIRED OF PERSON BEING FINGERPRINTED
FORM 147
REV MAY 2018
PRIVACY ACT STATEMENT/
Office Use only
SUBMISSION OF FINGERPRINTS /
PAYMENT OF FEES TO NSP-CID
NEBRASKA LIQUOR CONTROL COMMISSION
301 CENTENNIAL MALL SOUTH
Date Stamp HERE ONLY
PO BOX 95046
LINCOLN, NE 68509-5046
PHONE: (402) 471-2571
FAX: (402) 471-2814
Website: www.lcc.nebraska.gov
THIS FORM IS REQUIRED TO BE SIGNED BY EACH PERSON BEING FINGERPRINTED
:
DIRECTIONS FOR SUBMITTING FINGERPRINTS AND FEE PAYMENTS:
 FAILURE TO FILE FINGERPRINT CARDS AND PAY THE REQUIRED FEE TO THE
NEBRASKA STATE PATROL WILL DELAY THE ISSUANCE OF YOUR LIQUOR LICENSE
 Fee payment of $45.25 per person MUST be made DIRECTLY to the Nebraska State Patrol;
It is recommended to make payment through the NSP PayPort online system at
www.ne.gov/go/nsp
Or a check made payable to NSP can be mailed directly to the following address:
***Please indicate on your payment who the payment is for (the name of the person being
fingerprinted) and the payment is for a Liquor License***
The Nebraska State Patrol – CID Division
th
3800 NW 12
Street
Lincoln, NE 68521
 Fingerprints taken at NSP LIVESCAN locations will be forwarded to NSP – CID
Applicant(s) will not have cards to include with license application.
 Fingerprints taken at local law enforcement offices may be released to the applicants;
Fingerprint cards should be submitted with the application.
Applicant Notification and Record Challenge: Your fingerprints will be used to check the criminal history
records of the FBI. You have the opportunity to complete or challenge the accuracy of the information
contained in FBI identification record. The procedures for obtaining a change, correction, or updating a
FBI identification record are set forth in Title 28, CFR, 16.34.
Trade Name:__________________________________________________________________
Name of Person Bring Fingerprinted:_______________________________________________
Date of Birth:__________ Last 4 SSN:______ Date fingerprints were taken:__________
Location where fingerprints were taken:_____________________________________________
How was payment made to NSP?
☐NSP PAYPORT ☐CASH ☐CHECK SENT TO NSP CK # __________
My fingerprints are already on file with the commission – fingerprints completed for a previous
application less than 2 years ago? YES ☐
SIGNATURE REQUIRED OF PERSON BEING FINGERPRINTED
FORM 147
REV MAY 2018

Download Form 147 Privacy Act Statement/ Submission of Fingerprints / Payment of Fees to Nsp-Cid - Nebraska

919 times
Rate
4.4(4.4 / 5) 55 votes
ADVERTISEMENT