RES 2015-0754 - Appoint Allison M Dick manager of Curri ;:- EI L," L-
STATE OF NEBRASKA
7,1\
ZUlb MAI
Pete Ricketts 21 N1 1- 52 NEBRASKA LIQUOR CONTROL COMMISSION
Gouernor Hobert B. Rupe
/ Exec tithe Director
„zz CI-Y CLERK 301 Centennial Mal South 5th Floor
IO Box 95046
NEBRASKA Lincoln.!',:chraska 63509-5046
Phone(402 471-2571
I-hot 10-21471-2814 or 14021471-2374
TRS USER 800 833-7352 CITYi
%cub address:http."/"4.41M Ice ne goy/
May 27, 2015
OMAHA CITY CLERK
1819 FARNAM STREET LC-1
OMAHA NE 68183
RE: Manager Application Allison M. Dick
LICENSE #I-96895
Dear Clerk:
Enclosed is a copy of a manager application for Allison M. Dick, in connection with Curri, located in
Omaha.
Please present this application for manager to your City/Village Council or County Commissioners and
send us the results of their action.
Sincerely,
Jacqueline Rodriguez
Licensing Division
NEBRASKA LIQUOR CONTROL COMMISSION
402-471-2571
encl.
Janice M. Wiebusch Robert Batt Bruce Bailey
.,,,mssiotrer Cho rrhun Curnm.ss:ot,
C
MANAGER APPLICATION Office se
INSERT-FORM 3c p
NEBRASKA 1 1QtOR CO\1ROL CO\11,11SYON 4
301 CENTENNIAL NE Al 1 SOIJ CFI
PO BOX 95046
LINCOLN.Nh 68509-5046
PI IONE.(402)471-2571 A h
C 401_ CO
FAX:(402)471-2814
eb-,Ite: tt t1 ILA:tie.gtn
MUST BE:
V. Citizen of the United States. Include copy of US birth certificate, naturalization paper or
current US passport
✓ Nebraska resident. Include copy of voter registration in the State of Nebraska
✓ Fingerprinted. See Form 147 for further information, this form MUST be included with your
application.
✓ 21 years of age or older
Corporation/ILLC information — -
Name of Corporation/LLC: C 41/2/2 i VIC
Premise information Liquor License License Number: OcI6g9 c Class Type nos.appItLition blank)
Premise Trade Name/DBA: (tif lz I ivc
Premise Street Address: -
0
City: e County: Zip Code: 68M4f..
Premise Phone Number: - -0A 6-/e+ O
Email address: \JO Y 41 6:0 t-7#17
The individual whose name is listed as a corporate officer or managing member as reported on insert
form 3a or 3b or listed with the Comfoission. Click on this link to see authorized individuals.
littn://vvvm.lecale.v.ovilicense search/licsairch.cgi
SIGNATURE REQUIRED_BYCORPORATE OFFICER/MANAGING MEMBER
(Faxed lignatures are acceptable)
Form 103
RI 4 JAN 2015
Page 2 oio
Manager's information must be completed below PLEASE PRINT CLEARLY
Last Name: L I First Name: /7 / )67 / MI: ,
Home Address(include PO Box if applicable): it' .,.;? )
Count): i„ ±. Zip Code: Zig,/,/ 7
7 t,
lhome Phone Number: "11 t / :2 4— f c) Business Phone Number: 1/02. 0/1
Social Security Number: /rivers License Number& State:
Date Of Birth: Place Of Birth: 0/21.1{_i /
Email address: L.(. 'I //
Are you married?If yesi-colnplete spouse's information(Even if a spousal affidavit has been sui3irtitted)
YES NO
Spouse's information
Spouses Last Name: First Name:
Social Security Number: Drivers License Number& State:
Date Of Birth: Place Of Birth:
APPLICANT&SPOUSE MUST LIST RESIDENCE(S)FOR THE PAST TEN(10) YEARS
APPLICANT — SPOUSE
YEAR YEAR
CITY & STATE YEAR CITY & STATE YEAR
FROM TO FR()M TO
;61/ ei.,,ent
,
S e‘ ,a0// C.)fi,1‘,4-1/1 6A- / IL, 6 /% 2 ,24-z-S---
1? vo
:,,,26z) , /‘,/
(.;‘ Cc"
Form 103
RI V JAN 2015
Page 3 of 6
11MANAGER'SIASTVWO:EMPLOYERS'
YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE
FROM TO NUMBER
r-r 5 C,/7 i ' f s t'V G( !t j e f 1Yt11} ei `"Lic Z x 7 13/
I. READ CAREFULLY. ANSWER COMPLETELY AND ACCURATELY.
Must be completed by both applicant and spouse, unless spouse has filed an affidavit of non-
participation.
Has anyone who is a party to this application.or their spouse. EVER been convicted of or plead guilty to any charge.
Charge means any charge alleging a felony=, misdemeanor, violation of a federal or state law;a violation of a local law,
ordinance or resolution. List the nature of the charge. where the charge occurred and the year and month of the
conviction or pica. Also list any charges pending at the time of this application. If more than one party. please list
charges by each individual's name.
❑ YES NO
If yes.please explain below or attach a separate page. -
Date of Where Description -E*rj,AS K ;iy r
Name of Applicant Conviction Convicted ofi ° i in sit kn
(mm/yyyy) (City& State) Charge
l �•
?. Have you or your spouse ever been approved or made application for a liquor license in Nebraska or
any other state?
EYES NO
IF YES, list the name of the premise(s):
3. Do you, as a manager, qualify under Nebraska Liquor Control Act 053-131.01) and do you intend to
supervise, in person.the management of the business?
YES [—NO
ionn 03
RF:\JAN 2(0
P.U,4 of 6
111
4. List the alcohol related training and/or experience(when and where)of the person making application.
*NLCC Training Certificate Issued: Name on Certificate:
Applicant Name Date Name of program(attach copy of course completion certificate)
(mm/yyy+.)
i
For list ofNI,CC Certified Training Programs see _fcc-ne.gov traininginfo.html
Experience:
Applicant Name/Job Title Date of Name&Location of Business:
Employment:
�
iI1) oy1 l{ -f> (/J- rriit" (96/1-°NSf F=r.. (t? 'S }l 1flaki'' Vn 'ri'
5. Have you enclosed Form 1.17 regarding fingerprints?
61YES LINO
1
Form 103
REV JAN2015
Page 5 of 6
PERSONAL OATH ANWCONSENT OF INVESTIGATION
The above individual(s). being first duly sworn upon oath, deposes and states that the undersigned is the
applicant and/or spouse of applicant who makes the above and foregoing application that said application has
been read and that the contents thereof and all statements contained therein are true. If any false statement is
made in any part of this application, the applicant(s) shall be deemed guilty of perjury and subject to
penalties provided by law. (Sec §53-131.01) Nebraska Liquor Control Act.
The undersigned applicant hereby consents to an investigation of his/her background including all records of
every kind and description including police records, tax records (State and Federal). and bank or lending
institution records, and said applicant and spouse waive any rights or causes of action that said applicant or
spouse may have against the Nebraska Liquor Control Commission and any other individual disclosing or
releasing said information to the Nebraska Liquor Control Commission. If spouse has NO interest directly or
indirectly, a spousal affidavit of non participation may be attached.
The undersigned understand and acknowledge that any license issued, based on the information submitted in
this application, is subject to cancellation if the information contained herein is incomplete, inaccurate, or
fraudulent.
NERRR,SKA LIQUOR
Signature of tanager Applicant Signature of Spott,,i7pe C , §. € °
AC:KNOWLEDGEMI\`I
State of Nebraska
County of t, c2/l S The foregoing instrument was acknowledged before me this
date name of person acknnnn{edged
J s
Affix Seal
No ry Public si azure " G IIII III EIS it of wrist,
In compliance with the ADA. this application is available in other formats for persons with disabilities.
A ten day advance period is required in writing to produce the alternate format.
Toros I03
REV JAN 2015
Page 6 of 6
City of Omaha, Nebraska OMAHA „ 4._
4011111 .7
1819 Farnam — Suite LC 1 z , Pll) �
Omaha, Nebraska 681 83-01 1 2 � v.t*'4 ' � '^
Buster Brown iM
oo�. x a' !,,
Vi is t, ?_ ti
(402) 444-5550 A>.��� .-
City Clerk FAX (402) 444-5263 0,� " s 4�
1
1'4'0
FEBRU�
June 9, 2015
Curri, Inc. Application to appoint Allison M. Dick
Dba"Curri" manager of your present Class "I" Liquor
1028 South 74th Plaza License location
Omaha, NE 68114
Dear Liquor License Applicant:
This letter is notification that a hearing before the Omaha City Council on your application to
appoint a manager to the liquor license has been set for June 23, 2015 . The City Council
Meeting begins at 2:00 P.M. in the Legislative Chamber, (LC-4), Omaha/Douglas Civic Center,
1819 Farnam Street, Omaha, Nebraska. City Council Liquor Rule No. 6 states, "Each applicant
or his/her representative for any type of license shall be personally present in the Council
Chambers, in order that the Council may make inquiries, on the date of public hearing of the
application for said license". Failure to be present at this Council Meeting is grounds to
recommend denial of your application to the Nebraska Liquor Control Commission.
Sincer y yours,
ielato
Buster Brown
City Clerk
BJB:clj
OMAHA,
City ofOmaha, [ebra4a A 44.�
1819 Farnam — Suite LC 1 ` c ?,«
Omaha, Nebraska 68183-0112 � . r. 4'n 140V
qr
Buster Brown ��'y x A;t'
(402) 444-5550 A = _ tv
City Clerk FAX (402) 444-5263
TFD FE1303A
June 9, 2015
Allison Dick Application to be appointed manager of the
6235 Karen Street present Class "I" Liquor License location
Omaha, NE 68117 for Curri, Inc., dba "Curri", 1028 South 74th
Plaza
Dear Liquor License Manager Applicant:
This letter is notification that a hearing before the Omaha City Council on your application to be
appointed manager of the liquor license has been set for June 23, 2015 . The City
Council Meeting begins at 2:00 P.M. in the Legislative Chamber, (LC-4), Omaha/Douglas Civic
Center, 1819 Farnam Street, Omaha, Nebraska. City Council Liquor Rule No. 6 states, "Each
applicant or his/her representative for any type of license shall be personally present in the
Council Chambers, in order that the Council may make inquiries, on the date of public hearing
of the application for said license". Failure to be present at this Council Meeting is grounds to
recommend denial of your application to the Nebraska Liquor Control Commission.
Sincerely yours,
Jer 4P," "i‘Aelag
Buster Brown
City Clerk
BJB:clj
J
No. 7c�j
Curri, Inc., dba "Curri", 1028 South 74th Plaza
requests permission to appoint Allison M. Dick
manager of their present Class "I" Liquor
License location.
06-23-15;cj
\\.9
RECEIVED
Presented to Council:
June 23, 2015 - pproued 1'0
Buster Brown
City Clerk