Fillable City of Lincoln Lincoln Police Department High Value (Nebraska)

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City of Lincoln Lincoln Police Department High Value (Nebraska)

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Permit # ______________
LPD Records
575 S. 10
th
Street, Lincoln NE 68508
402-441-7210
LPD1197 | 10-2021
City of Lincoln
Lincoln Police Department
High Value Salvage and Regulated Metals
Collector Permit Application
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
BUSINESS Complete Business Section, If Applicable
Business Name:_________________________________________________________________________
Business Address: _______________________________________________________________________
City: __________________________________ State: ______________ Zip Code: __________________
Business Phone #: (________) _________________________
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PERSONAL
Name: ________________________________ __________ ___________________________________
FULL FIRST MI LAST
Address: _______________________________________________________________________________
City: __________________________________ State: ______________ Zip Code: __________________
Phone #: (_____) _______________________ Email: __________________________________________
Date of Birth: ____________ Driver’s License or Photo ID #: _______________________ State: ________
Have you been convicted of any theft offense within the last 5 years? ☐ Yes ☐ No
This includes:
• Burglary
• Possession of burglar’s tools
• Theft by unlawful taking
• Theft by shoplifting
• Theft by deception
• Theft by extortion
• Theft of property lost, mislaid, or
delivered by mistake
• Unauthorized use of propelled
vehicle
• Theft by receiving stolen property
• Receiving stolen goods
• Larceny
• Shoplifting
• Theft of services
• Unauthorized entry into motor vehicle
• Taking possession of property
without consent of owner
__________________________________________ ______________________________
Applicant Signature Date
NOTE: Any issued permit expires on the 31
st
of July following the date of issuance.
☐ New
☐ Renewal
For Office Use Only:
Paid $5.00 by: ☐ cash or ☐check Receipt #: ___________________
Permit: ☐ Approved ☐ Denied
__________________ __________________
LPD Employee # Date Processed
Applicant’s Fingerprint
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City of Lincoln Lincoln Police Department High Value (Nebraska)

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Completed 6 April 2022

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