Fairmont, NE · Fillmore County
Citizen Liquor License Complaint Affidavit
This sworn complaint form lets five Fairmont residents report an alleged violation of liquor regulations to the Village Board, identifying the licensee, relevant rule, and facts behind their complaint.
At a glance
- Issued by
- City of Fairmont · Fairmont, Fillmore County, Nebraska
- Notarization
- Required: sign this form in front of a notary before filing it.
- Official source
- fairmont-nebraska.org
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
- licensed online notary
- ~15 min average
- Notarized PDF emailed
What you’ll need
- Government-issued photo ID
- Webcam-enabled device (laptop or phone)
- This form, ready to upload as a PDF
What this form is
Included in Fairmont’s business regulations chapter, this prescribed form is for five village residents who want to complain that a retail liquor licensee has violated the Nebraska Liquor Control Act, commission regulations, or village code. The complainants identify the licensee and the provision at issue, describe the supporting facts, and sign under oath. The chapter says the written complaint must be signed and sworn, and describes the Village Board’s process for handling it.
Who needs it
Five Fairmont residents who wish to file a written complaint with the Village Board about an alleged violation by a retail liquor licensee need to complete and swear to this form.
Why it needs a notary
The form carries a State of Nebraska and Fillmore County jurat; all five resident complainants sign and swear to the complaint before the notary.
How to get this notarized
- 1
Download the Chapter
Download Fairmont’s Business Regulations chapter and locate the Citizen’s Complaint form in the alcoholic beverages section.
- 2
Complete the Complaint
Have five Fairmont residents identify the licensee, the provision they believe was violated, and the supporting facts.
- 3
Book an Online Notary
Arrange a remote notarization for the five complainants and check that the notary can complete the form’s jurat.
- 4
Sign on Video
Each complainant signs and swears to the complaint during the online notarization.
- 5
Submit to the Village
Submit the completed complaint to the Fairmont Village Board as directed by the village.
Preview the form
The blank PDF straight from Fairmont. Look it over, then upload your filled copy to start the notary session.
You’ll need ID and a webcam.
A licensed online notary will join you on video, verify your government-issued ID, witness your signature, and apply their seal. You’ll receive the notarized PDF by email when the session ends.
Frequently asked questions
- How do I file this liquor license complaint?
- Five Fairmont residents complete the complaint with the licensee, provision at issue, and supporting facts, then sign and swear to it before a notary. The form directs the complaint to the Village Board.
- Do I need all five complainants to sign before a notary?
- Yes. The prescribed form provides five complainant name lines and a jurat stating that the complaint is subscribed and sworn to by those complainants.
- Can I sign this form with a commissioned online notary?
- Nebraska authorizes remote online notarization by its notaries under the Online Notary Public Act, Neb. Rev. Stat. §§64-401 to 64-420. Section 64-201 recognizes notarial acts by a notary or other authorized officer of another state. Confirm with the city if unsure.
- What information does the complaint ask for?
- The form asks complainants to state that they are Fairmont residents, identify the licensee and license class, specify the law, commission regulation, or village code provision, and explain the facts supporting their belief.