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 |
|
|
| 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 |
Form Used to Order Receipt Books for Recording Pickle Card Sales to Pickle Card Operators |
Pickle Card Operators
| Form Title | Form # | Document |
|---|---|---|
| Schedule II, Authorization for Pickle Card Operators Application | 50 |
Form filed by organizations authorizing pickle card operators to sell their cards |
| Nebraska Application for Pickle Card Operator | 50D |
|
| Nebraska Registration and Report of Pickle Card Dispensing Devices | 50F |
|
Manufacturers and Distributors
| Form Title | Form # | Document |
|---|---|---|
| Nebraska Application for Manufacturers, Distributors, and Manufacturer-Distributors | 50A |
Manufacturers, Distributors, and Manufacturer-Distributors Application |
| Nebraska Distributor of Pickle Cards Tax Return | 51A |
|
| Schedule I, Distributor Activity Report | 51A, Sch. I |
Schedule I, Pickle Card Distributor Activity Report File with Distributor Tax Return |
| 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 Gaming Licensees |
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| 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 |
| Reconciliation of Deposits to Sales | Reconciliation of Deposits to Sales Worksheet |
