Nebraska State Fire Marshal - Forms

Forms – Fireworks

Forms with a PDF format require Adobe Acrobat Reader to view the files. Forms with a format of DOT (Word template) require Microsoft Office 2000 or higher to view. These files, except where the format is indicated as Online, must be saved to your hard drive prior to completing them. To download these files, right click on the link and select “Save Target as…” Specify the Desktop or another directory on your hard drive, such as My Documents, where you want to save the file. Unless indicated otherwise, forms that require fees, signatures and/or other documentation must be mailed to the State Fire Marshal’s Office at 246 South 14th Street, Lincoln, NE 68508-1804. If these forms are emailed it will delay processing.

Fireworks Injury Report
Format: PDF File size: 68 KB
Posted: 6/2/2005

The Fireworks Injury Report is used by the State Fire Marshal’s Office to learn of injuries and other pertinent information of the injury resulting from the use of fireworks. This information is for statistical purposes only. The form should be completed by any hospital emergency room or facility providing emergent care that treats a firework-related injury only during the study period of June 25 – July 5 each year.
Fireworks License Application
Format: PDF File size: 52 KB
Posted: 2/9/2006
Format: Online

The Fireworks License Application should be used by anyone applying for a license to be a Distributor or Jobber for fireworks or to have a retail stand(s) in the State of Nebraska. The PDF version must be mailed in with a check or money order for the appropriate fees. The online application will only be available January 1 thorough 5 pm June 30 each year.
Fireworks License Application Change Form
Format: PDF File size: 52 KB
Posted: 2/9/2006

The Fireworks License Application Change Form must be completed by anyone holding a retail license for any changes that need to be made to the original license. Be sure to enter the license number or the original license so the correct license is amended. The online application will only be available January 1 thorough 5 pm June 30 each year.
Fireworks Display Operator’s License Application
Format: PDF File size: 44 KB
Posted: 5/8/2008
Format: DOT File size: 90 KB
Posted: 5/8/2008

This application must be completed to obtain a Display Operator’s License. You may email the DOC or DOT version to Nicki.
Public Fireworks Display Permit Application
Format: PDF File size: 17 KB
Posted: 3/12/2005
Format: Online

The Public Firework Display Permit application must be completed and approved by this office for any display involving Class B fireworks.
Public Firework Display Permit Application Change Form
Format: PDF File size: 14 KB
Posted: 3/12/2005

The Public Firework Display Permit Application Change Form must be completed for any change to be made to the original Permit Application.

Page last updated May 8, 2008



MENU	Forms – Fireworks Forms with a PDF format require Adobe Acrobat Reader to view the files. Forms with a format of DOT (Word template) require Microsoft Office 2000 or higher to view. These files, except where the format is indicated as Online, must be saved to your hard drive prior to completing them. To download these files, right click on the link and select “Save Target as…” Specify the Desktop or another directory on your hard drive, such as My Documents, where you want to save the file. Unless indicated otherwise, forms that require fees, signatures and/or other documentation must be mailed to the State Fire Marshal’s Office at 246 South 14th Street, Lincoln, NE 68508-1804. If these forms are emailed it will delay processing. Fireworks Injury Report Format: PDF File size: 68 KB Posted: 6/2/2005 The Fireworks Injury Report is used by the State Fire Marshal’s Office to learn of injuries and other pertinent information of the injury resulting from the use of fireworks. This information is for statistical purposes only. The form should be completed by any hospital emergency room or facility providing emergent care that treats a firework-related injury only during the study period of June 25 – July 5 each year. Fireworks License Application Format: PDF File size: 52 KB Posted: 2/9/2006 Format: Online The Fireworks License Application should be used by anyone applying for a license to be a Distributor or Jobber for fireworks or to have a retail stand(s) in the State of Nebraska. The PDF version must be mailed in with a check or money order for the appropriate fees. The online application will only be available January 1 thorough 5 pm June 30 each year. Fireworks License Application Change Form Format: PDF File size: 52 KB Posted: 2/9/2006 The Fireworks License Application Change Form must be completed by anyone holding a retail license for any changes that need to be made to the original license. Be sure to enter the license number or the original license so the correct license is amended. The online application will only be available January 1 thorough 5 pm June 30 each year. Fireworks Display Operator’s License Application Format: PDF File size: 44 KB Posted: 5/8/2008 Format: DOT File size: 90 KB Posted: 5/8/2008 This application must be completed to obtain a Display Operator’s License. You may email the DOC or DOT version to Nicki. Public Fireworks Display Permit Application Format: PDF File size: 17 KB Posted: 3/12/2005 Format: Online The Public Firework Display Permit application must be completed and approved by this office for any display involving Class B fireworks. Public Firework Display Permit Application Change Form Format: PDF File size: 14 KB Posted: 3/12/2005 The Public Firework Display Permit Application Change Form must be completed for any change to be made to the original Permit Application. Page last updated May 8, 2008
246 South 14th Street; Lincoln, NE 68508-1804; Phone: (402) 471-2027; Fax: (402) 471-3118