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Get NE LCC 35-7500 2015

Use Only Complete This Entire Form Trade Name Premise Address Mailing Address City, County Phone # State Zip Code License # Nebraska Enter Period Covered: from to MO/DT/YR MO/DT/YR Gross Revenues by Type - Section One $ Monthly Revenues Cigar Revenues NOV DEC JAN period 2 FEB MAR APR period 3 MAY JUN JUL period 4 AUG SEP OCT Total Other Tobacco Products Revenues Tobacco Related Products Revenues Alcohol Products Revenues Misc Revenues $0.00 $0.00 $0.00 $0.00 $0.00 Column 1 Colu.

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