Pickle Card Forms

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Printing Instructions

Many of the files below are in Adobe Acrobat format. Selecting a file will load it into the Acrobat Reader, which will allow you to print it. If you have trouble downloading or printing, you probably need to install or upgrade your Acrobat Reader.

Install the Acrobat Reader (Version 5.0 or higher is recommended) if you do not yet have it installed on your computer.

Some 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.

If you experience problems with downloading forms, it is recommended that you upgrade to Adobe Reader 5.0 or higher. Please note that the "Fill-able" forms are a larger file size and will take longer to download.

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Class I Pickle

Class II Pickle

Pickle Card Operators Manufacturers & Distributors

Miscellaneous

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Class I Pickle

Applications:

Checklist (Make Sure Your Application is Complete)  
Instructions for Completion of 2008-2010 BIENNIAL License Renewal Application
Form 50, Nebraska Application for Bingo, Lottery, or Lottery by Pickle Card
[Fill-in Form 50]
Form 50H, Nebraska Application for Utilization of Funds Member
[Fill-in Form 50H]
Form 50F, Nebraska Registration and Report of Pickle Card Dispensing Devices
[Fill-in Form 50F]
Instructions for Completion of 2007 Pickle Card Dispensing Device Registration Renewal

Reporting Forms:

Form 51A, Nebraska Distributor of Pickle Cards Tax Return
[Fill-in Form 51A ]
Form 51A, Schedule I, Distributor Activity Report
[Fill-in Form 51A, Schedule I]
Form 35A, 2007-2008 Nebraska Lottery by Pickle Card Annual Report
[Fill-in Form 35A]
Nebraska Pickle Card Sales Invoice and Receipt Reorder Form

Class II Pickle

Applications:

Checklist (Make Sure Your Application is Complete)
Instructions for Completion of 2008-2010 BIENNIAL License Renewal Application
Form 50, Nebraska Application for Bingo, Lottery, or Lottery by Pickle Card
[Fill-in Form 50]
Form 50H, Nebraska Application for Utilization of Funds Member
[Fill-in Form 50H]
Form 50, Schedule II, Authorization for Pickle Card Operators Application
[Fill-in Form 50, Schedule II]
Form 50E, Nebraska Application for Pickle Card Sales Agent
[Fill-in Form 50E]
Form 50F, Nebraska Registration and Report of Pickle Card Dispensing Devices
[Fill-in Form 50F]
Instructions for Completion of 2007 Pickle Card Dispensing Device Registration Renewal
Instructions for Completing Fingerprint Application

Reporting Forms:

Form 35A, 2007-2008 Nebraska Lottery by Pickle Card Annual Report
[Fill-in Form 35A]
Nebraska Pickle Card Sales Invoice and Receipt Reorder Form

Pickle Card Operators

Form 50D, Nebraska Application for Pickle Card Operator
[Fill-in Form 50D]
Form 50F, Nebraska Registration and Report of Pickle Card Dispensing Devices
[Fill-in Form 50F]
Instructions for Completion of 2007 Pickle Card Dispensing Device Registration Renewal
Instructions for Completing Fingerprint Application

Manufacturers & Distributors

Form 50A, Nebraska Application for Manufacturers, Distributors, and Manufacturer-Distributors
[Fill-in Form 50A]
Form 51A, Nebraska Distributor of Pickle Cards Tax Return
[Fill-in Form 51A]
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
[Fill-in Personal History Record]
Affidavit by Spouse for Waiver of Fingerprinting and/or Personal History Record and Background Disclosure Form for Charitable Gaming Licensees
[Fill-in Affidavit]
Instructions for Completing Fingerprint Application

Miscellaneous

Form 21, Application for Abatement of Penalty
[Fill-in Form 21]
Form 33CG, Power of Attorney for Charitable Gaming Use
[Fill-in Form 33CG]
Computation of Pickle Card Sales
Reconciliation of Deposits to Sales
Sample Reconciliation of Deposits to Sales
Sample Pickle Card Check Ledger

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