Bingo 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 Bingo
| 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 |
|
| Schedule I, Bingo License | Applications | 50 |
|
| Nebraska Application for Utilization of Funds Member | Applications | 50H |
|
| Nebraska Bingo Tax Return | Reporting | 51B |
|
| Schedule I, Bingo Occasion Activity Report | Reporting | 51B |
|
| Nebraska Class I Bingo Annual Report - View and Print Only | Reporting | 35 |
|
Class II Bingo
| 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 |
|
| Schedule I, Bingo License | Applications | 50 |
|
| Nebraska Application for Utilization of Funds Member | Applications | 50H |
|
| Nebraska Application for Gaming Manager | Applications | 50C |
|
| Instructions for Completing Fingerprint Application | Applications |
|
|
| Background Check Waiver | Applications |
|
|
| Nebraska Bingo Tax Return | Reporting | 51B |
|
| Schedule I, Bingo Occasion Activity Report | Reporting | 51B |
|
| Nebraska Class II Bingo Quarterly/Annual Report - View and Print Only | Reporting | 35C |
|
Special Event Bingo
| Form Title | Form # | Document |
|---|---|---|
| Nebraska Application for Special Event Bingo Permit | 50J |
|
Commercial Lessor
| Form Title | Form # | Document |
|---|---|---|
| Nebraska Application for Commercial Lessor of Bingo Premises | 50B | Commercial Lessor Application |
| Schedule I, Registration of Bingo Premises | 50B | Bingo Premises Registration |
Manufacturer & Distributor
| Form Title | Form # | Document |
|---|---|---|
| Nebraska Application for Manufacturers, Distributors, and Manufacturer-Distributors | 50A |
Manufacturers, Distributors, and Manufacturer-Distributors Application |
| 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 |
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 Ga |
|
|
| Instructions for Completing Fingerprint Application |
|
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| Background Check Waiver |
|
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| Nebraska Licensed Manufacturers |
|
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| Nebraska Licensed Distributors |
|
Miscellaneous
| Form Title | Form # | Document |
|---|---|---|
| Request for Abatement of Penalty | 21 | Abatement of Penalty Request Form |
| Power of Attorney | 33 | Power of Attorney Application |
