Required Privileged Business License Application Forms

Privileged Licensing Application Packet
Privileged Licensing Application Packet forms are required for all privileged licenses:  The Nevada Business Registration Form (NBR), Business License Supplement Form, Fire Department's Permit Survey Form, Affirmation of Compliance (Industrial Insurance) Form, Compliance/Exemption Form (SB356), Floor Plan and L&G Instructions.

1. Nevada Business Registration Form
   The Nevada Business Registration Form (NBR) is the main part of the application and must be completed. An advantage of this form is that it is also utilized by most state agencies; therefore you do not have to repeat all the pertinent information to each agency. The NBR has specific directions; please be sure to read it carefully and completely fill out the document.
2. Business License Supplement Form
   The Business License Supplement is a form for the Business License Department and must also be completed.
3. Fire Department Permit Survey Form
   Completion of the Clark County Fire Permit Survey Form is required of all applicants.
4. Instructions for Scheduling Fire Department Inspections Online
   The Instructions for Scheduling Fire Department Inspections will enable Business License applicants to schedule their Fire Department inspection online. 
5. Worker’s Compensation
   Industrial Insurance requires an Affirmation of Compliance with Mandatory Industrial Insurance Requirements, which indicates you have complied with industrial insurance coverage requirements in Nevada (NRS616). The form needs to be completed; "signed in the presence of a business license technician”; and submitted to the Business License Office prior to the issuance of a business license. If this form is mailed or faxed to our office, it must have the signature notarized. If you have questions or need more information regarding this form, contact the State of Nevada, Department of Business & Industry, Division of Industrial Relations, Industrial Insurance Regulation Section, 1301 North Green Valley Parkway, Suite 200, Henderson, NV  89104, (702) 486-9000.
6. Child Support Documents
   The Compliance/Exemption Forms (SB356) are required by Clark County Business License Department to ensure that business license applicants are in compliance with court orders dealing with child support payments. This must be completed in order to process your business license application.
7. Floor Plan
   An interior diagram or floor plan of your business on an 8-1/2 x 11 sheet of paper is required. Indicate the total size of location in square feet and the total number of restaurant and bar seats. Include location of store room, cash register, slot machines, restrooms, kitchen, dining tables, bar, etc. (including location and description of physical barriers between restaurant/dinng areas and any bar/lounge areas.
8. L & G Instructions
   A short letter from the Department of Business License to all privileged business license applicants providing L & G Instructions on filing their applications.

Business License Waiver
The Business License Waiver Form is required, due to the high volume of investigations completed by the Department of Business License and Las Vegas Metropolitan Police Department.  We are unable to predict when an applicant’s determination of suitability will be completed and ready for presentation to the Liquor and Gaming Licensing Board for action.  Nevada state law requires that applicants be notified, in writing, at least 21 working days prior to being included on a public agenda. In most cases, the Department and Metro are prepared to present cases to the Board under that 21-day window, so we ask that applicants waive that 21-day window so as to better serve their interest and enable us to place their item on the next available agenda.

Required Application Forms
for the Different Types of Privileged Business Licenses

In addition to the Privileged Licensing Application Packet and the LVMPD Forms required by the Las Vegas Metropolitan Police Department, below are other forms needed, to obtain a privileged license.

1. Gaming Application Forms
2. Liquor Application Forms
3. Liquor and Gaming Application Forms

1. Personal Financial Questionnaire
   You must provide one (1) original and one (1) copy of the Las Vegas Metropolitan Police Department Personal Financial Questionnaire once completed, with notarized signatures. Provide documents showing source and availability of your personal funds invested and loan documents, if applicable. Documentation of secured funding must be available at the time of application. Letters of Intent will not be accepted and will delay the processing of your application. Two (2) copies of the applicant’s past three (3) years of federal income tax filings and last three (3) months of bank statements are required for each person.
2. Corporate Financial Questionnaire
   Any privileged and/or certain regulated businesses that are owned by an entity registered with the Secretary of State will be required to complete a form detailing the financial history, including bank accounts, investments and past income tax information. This form requires notarized signatures in several places. A copy of the entities past three (3) years of federal income tax filings and last three (3) months of bank statements are required to be attached to this form.
3. Business Supplemental Questionnaire
   In addition to the Personal History Questionnaire, a Business Supplemental Questionnaire is needed, in order to conduct the necessary background investigation, in relation to the business.

OTHER PRIVILEGED BUSINESS Forms

Key Employee
You will be redirected to the Key Employee Forms.

Liquor and Gaming Miscellaneous
You will be redirected to the Liquor and Gaming Miscellaneous Forms.

Change Forms
Change Forms packet includes: Checklist for Change of Business License; Application for Change of Business License (including Applicable License Changes and Fees) and Fire Permit Survey are included in this packet.

Complaint Form
All complaints must be received in writing.  The complaint form contains all the information we need to investigate a complaint including a return address and a fax number.

Fictitious Firm Name Form
Need to file a Fictitious Firm Name? Read about the County Clerk requirements if you plan to officially "name" your business. There is some excellent information for you on their website and you will have all the information you need to file your fictitious firm name. This form needs to be filed prior to applying for a Business License.

Key Employee Forms
Key employees (individuals who have the power to exercise a significant influence over decisions concerning any part of the operation of a liquor and gaming establishment) must fill out these forms.

Out of Business Form
Complete the Out of Business Form to notify Clark County Business License that your business is no longer operating.

Request for Duplicate License Form
Obtaining a duplicate license can be accomplished by completing the Request for Duplicate License Form.  License reprint fee $5.00.

Request for Refund Form
Request for monies to be refunded can be accomplished by completing the Request for Refund Form.

Request for Temporary Liquor License
The proposed new owner of an established, licensed, and operating business with a liquor license may request the Department of Business License to issue a Temporary Liquor License to protect the goodwill of the business with their existing clientele.

Request to Surrender Gaming License Form
Surrender of your gaming business license can be accomplished by completing the Request to Surrender Gaming License Form.

Request to Surrender Liquor License Form
Surrender of your liquor business license can be accomplished by completing the Request to Surrender Liquor License Form.