The form may be completed online; however, it cannot be submitted via e-mail due to the fact that all applications and forms require original signatures. If you complete the form online, you must print the form, sign it, and mail it to the address below.
A duplicate or reissued license is available for a fee of $10.00. Duplicate/Reissue Form
Long Term Care Section
PO Box 94986
Lincoln, NE 68508-9486
Facilities and Services Home
Licensure Unit Home
PDF format require the use of Adobe Acrobat Reader