§ 111.23 FORM FOR CITIZEN COMPLAINTS.
   The following form is hereby prescribed for the use of residents of this city desiring to complain to the Mayor and the City Council that any licensee is violating any provision of the State Liquor Control Act, being Neb. Rev. Stat. §§ 53-101 et seq., regulations prescribed by the State Liquor Control Commission or any provision of this chapter.
 
To the Mayor and City Council of the City of Valley, Nebraska.
 
The undersigned respectfully state:
 
1.   That they are each residents of the City of Valley, Nebraska.
 
2.   That they believe that        , the holder of a Class       license in the aforesaid city, has violated Section        of (check one or more)
 
           the Nebraska Liquor Control Act.
           the regulations prescribed by the Nebraska Liquor Control Commission.
           the Municipal Code of the City of Valley, Nebraska.
 
3.   That the aforesaid belief is based on the following facts, to-wit:
                                                                                                                                                                                                                                                                                         
 
                                                        
(Name)            (Name)
                                                        
(Name)            (Name)
                            
(Name)
 
STATE OF NEBRASKA      )
) ss.
COUNTY OF DOUGLAS   )
 
Subscribed in my presence and sworn to before me by                            ,
                            ,                            ,                             and                            , this                             day of                            , 20                            .
 
                               
   Notary Public
My commission expires                            .
 
(Prior Code, § 4-208)
Statutory reference:
   Similar provisions, see Neb. Rev. Stat. § 53-134.04