I hereby certify that information provided on this application is true and correct to the best of my knowledge.
I hereby consent to review of any law enforcement records or reports concerning myself by representatives of the Nebraska Racing Commission.
I understand that failure to provide true and complete information, or failure to comply with Nebraska Rules of Racing may result in denial or revocation of this license. I understand as a licensee that I must disclose to the stewards and the commission any suspensions or revocations from any other jurisdiction while my Nebraska License is in effect. I must disclose this information no later than seventy-two (72) hours after the ruling has been issued.
I agree this application is executed and delivered by electronic means and upon such delivery the electronic signature will be deemed to have the same effect as if the original signature had been delivered to the other party.