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PLC:

a002ry

Agency:

lincoln county sheriffs office

For:

paper service & liquor licenses

Phone:

775-962-5151

Address:

225 justice way
pioche, nevada 89043

*Required Field

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*Contact Name:

Middle:

*Last:

Business Name:

*Fee Type:

Notes:

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Payment Amount :

Subtotal:

$0.00

Total:

$0.00

Billing Information

*First Name:

Middle Initial:

*Last Name:

*Billing Address:

*City:

*State/Province:

*Zip:

*Country:

*Phone Number:

*Credit/Debit Card:

(enter the full card number without any dashes or spaces)

*Expiration Date:

*Card Security Number:

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