RES 2015-0663 - Appoint Robert J Diesing manager of Bucky's Express #12 NECc: V E D
. , , L-
i:,';'''- ' ' IA STATE OF NEBRASKA
20 c15 MAY 21 PI 11• ,,t4
. NEBRASKA LIQUOR CONTROL COMMISSION
Governor Hobert B.Rupe
Executwe Director
301 Centennial Mall South.5th Floor
CiT I CLERK P.O.Box 95046
Lincoln.Nebraska 68509-5046
KA
n1,1 AH ! , NEBRAS Phone(402)471-2571
Fax(402)471-2814 or(402)471-2374
IRS USER 800 833-7352 CITY)
web address bop liwww.lce ne got.,'
May 20, 2015
OMAHA CITY CLERK
1819 FARNAM STREET LC-1
OMAHA NE 68183
RE: Manager Applications Robert J. Diesing
LICENSE .D-70766 #D-53987, #D-72419, &#D-69818
Dear Clerk:
Enclosed is a copy of a manager application for Robert J. Diesing, in connection with the ud=1.
Ex ra... 2 3ucky's Express 13, Bucky's Express 18, and the Bucky's Express 20,all 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,
/' e
t?'•Cj-e%A..1-..
I /
Jacqueline Rodriguez
Licensing Division
NEBRASKA LIQUOR CONTROL COMMISSION
402-471-2571
end.
Janice M.Wiebusch Robert Batt Bruce Bailey
CommtssIoner Ch nhaaa, Com rrassloner
An Equal Opporruhav Ern r,loter
MANAGER APPLICATION Office Use
INSERT-FORM 3c
NEBRASKA LIQUOR CONTROL COMMISSION
301 CENTENNIAL MALL SOUTH
PO BOX 95046
LINCOLN NE 68509-5045
PHONE:(402)471.2571
FAX:(402)471-2814
Website:www'.Ice.rle;gry
MUST BE.
✓ Citizen of the United States. Include copy of US birth certificate,naturalization paper or
current US passnort
✓ Nebraska resident. Include cony of voter registration in the State of Nebraska
✓ Fingerprinted. See Form 147 for further information,this form MUST be included with your
application.
v' 21 years of age or older
gg, ",.a. t ' Y. =� � m.�'7 .. .. ,„
Name of Carporation/LLC:Buck'i Inc
D
Liquor License Number 7C 7 Class Type of new appbcanonlease blank)
Premise Trade Name/DBA:Bucky's Express #12
Premise Street Address: 10202 Maple Street
mi
City: County:County:Douglas ip o e 8"134
Premise Phone Number 402 571 0134 P 1 0 2015
bdiesing@buchananenergy.com buchananenergy.corn E SK LIQUOR
Email address: CONTROL M I5S O
N
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 Com ission. Click on this link to see authorized individuals.
Mtn://www.lcc.ne.eov/license search r h.cei
ONATVRJ « Q ` D Y 'e E, ? C� 4! �'° , E t
(Faxed sig atures are acceptable) _.
Form 103
REV MAN 2015
Page 2 of 6
" a - .� t' o—, tt a.� 4
Last Name: Diesing First Name:Robert MI:
Home Address(include PO Box if applicable): 1005 E Aberdeen Drive
City:Papillon County:Sarpy Zip Code:68046
Home Phone Number:402 597 3172 Business Phone Number:402 558 9860
Social Security Number: Drivers License Number& State:
Date Of Birth. Place Of Birth:Omaha NE
Email address:bdiesing@buchananenergy.com
n YES Q NO
a ;wru� v' � t�is9hii� ''«
1,11 * �'�:
Spouses Last Name:Diesing First Name:Sheri MI:`'
Social Security Number: Drivers License Number&State:
Date Of Birth: Place Of Birth:Omaha NE
Y 4 .x t4, R .i +a,.�: a o 're x'441 AL
YEAR YEAR
CITY& STATE YEAR YEAR CITY& STATE
FROM TO
Papillion NE 1998 2015 Papillion NE 1998 2015
Form 103
REV JAN 2015
Page 3 of 6
YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE
FROM TO NUMBER
2011 2015 Buck' Inc Steve Kapple 402 558 9860
2007 2011 Premier Beverage Mark Wright 402 891 1212
1. 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 plea. Also list any charges pending at the time of this application. If more than one party, please list
charges by each individual's name.
n YES E NO
If yes,please explain below or attach a separate page.
Date of Where Description
Name of Applicant Conviction Convicted of Disposition
(mmlyyyy) (City&State) Charge
2. Have you or your spouse ever been approved or made application f+ tuti in Nebraska or
any other state?
OYES EtNO APR 1 0 Z015
IF YES,list the name of the premise(s): NEBRASKA LIQUOR
CONTROL M i 'O
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
Form 103
REV JAN 2015
Page 4 of()
4. List the alcohol related training and/or experience(when and where)of the person making application.
*NLCC Training Certificate issued: RBST Name on Certificate: Robert Diesing
Applicant Name Date Name of program(attach copy of course completion certificate)
(mmIYYYY)
Robert Diesing 04/2015 RBST Nebraska
*For list of NLCC Certified Training Programs see www.lec.ne.gov; raininginfo.html
Experience:
Applicant Name/Job Title Date of Name& Location of Business:
Employment.
Robert Diesing/Beverage Category Manager Aug 2011 Buck's Inc 7315 Mercy Road Omaha Ne 68124
•
5. Have you enclosed Form 147 regarding fingerprints?
NE
*YES ONO
APR 1 0 2015
NEBRAA LIQUOR
CONTROL COS.
Form 103
REV JAN 2015
Page S of 6
ae4��,�� '��. $m �' � � •'"'". §fig i�% a zt��s ;�` ,' �p�
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.
r)k.
� ..�
Signature f Manager Applicant Signature of Spouse
ACKNOWLEDGEMENT
State of Nebraska
County of i:)t)v 1 I q 5 The foregoing instrument was acknowledged before me this
- 7- &ntC' by }�2S1Y
date name of person acknowledged
Is72/1.4.?: - Affix seal
Plata ublic signature 6EMMAL.NOTARY-SteaotNetraska
LEEANN F NOBLE
11✓ .Exp.Myth 10,Mitt
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.
Form 103
REV JAN 2015
Page 6 of 6
i',V;I•ltirriijillier
Office Use
SPOUSAL
AFFIDAVIT OF
INSERT
NON PARTICIPATION
NEBRASKA CONTROLLIQUONIRALL
301 CENTENNIALCOMMISSION
P°BOX 950
46 68509-5046
S SOUTH
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' 'illataV"'"'-.1.;=..--
LINCOLN,
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PHONE:(4 ON2E) 71-257 1
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for waiver Sheri Diesing
listed
Signature askingfoifnsdpiovuidsueal below) name of spouse asking for waiver
before me this
(Spouse o
Nebraska
State of
Douglas
knavdedged
County of
by
name of person April 7 2015
SheriThe fpoireseginogingjet*instrument acknowledgedwrsaosnac
081134/6rARY.State°f eLE
date name
Affix Seal
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re LEEANN F NO
Notary Public si
lorr7,,.,
I understand th41%-spouse'and I are 1:- ",' 13
,,,,itiooialtst -100t:: iii-,4theabove: int...! -.11rs.',. ....?,
,,, ',-, ---,, ii-acknowledge„tbat-,, spouse above. If determined.
'rrff7, ' the
,,' ' ' set' RPt: license.
compliance
with:; -9,f1 revoke ihi,Liquor
RECEIVED
Commission
.
. .
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APR 1 clic,0 Zu.--,
with application
01,1°R
individual involvedRobe_rt Diesing
ii,u0Asi<P, 4--1
above) Printed name of applying
this
Signature o . . * individual
(Spouse of individual listed
Gilga9
ent
Nebraska
,.7nstrum The foregoingi
State of
Douglas
Robert Diesiag
County of
by Ilddrged before me
April 7 2015
date
Affix Seal 4.k
LEE
ANN F
name of person acknowledged
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teak NotARY-StateN:018Nea,brLxnEaska7 1
Notary Public signa re My Corn mar
format.
ON Revised 1/2
the ADA,this spousal affid to produce the alternate
Incompliance
with is requested in writing
A ten day advance periodavit of non participation is available in other formats for persons with disabilities
FORM 354178
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RECEIVED
2015 WIMP
NEBRASKA LIQUOt
CONTROL COMMISSION
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City of Omaha, Nebraska 014."4/ft
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alitrnk1819 Farnam — Suite LC 1 ► iirk tt ^
Omaha, Nebraska 681 83-01 1 2 � ii
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Buster Brown (402) 444-5550 ti,
City Clerk FAX (402) 444-5263 pdtt
May 26, 2015
Buck's, Inc. Application to appoint Robert J. Diesing
Dba"Bucky's Express #12" manager of your present Package Liquor
10202 Maple Street Liquor License location
Omaha, NE 68134
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 9, 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,
Buster Brown
City Clerk
BJB:clj
City of Omaha, Nebraska OMAH,,!
A N
111k14 ---
1819 Farnam — Suite LC 1 z � r
Omaha, Nebraska 68183-0112 _ r'_r*A . ,. a°
Buster Brown (402) 444-5550
City Clerk FAX (402) 444-5263 � � 4
94FD FEBRUA
May 26, 2015
Buck's, Inc. Application for a Package Liquor License
Attn: Bob Diesing and Manager's application for Buck's, Inc.
7315 Mercy Road (See attached list of locations)
Omaha,NE 68132
Dear Liquor License Applicant:
This letter is notification that a hearing before the Omaha City Council on your application for
liquor license has been set for June 9, 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.
Ordinance No. 37046, passed June 27, 2005, requires each applicant to submit a written statement
describing all types of business or activities that will be operated on the premises in conjunction
with the proposed license. Attached is the statement to be signed and returned (hand deliver,
mail or fax) to the City Clerk's Office 7 days in advance of the public hearing.
Sincerely yours,
�.v
.e‘t.o ",
Buster Brown
City Clerk
BJB:clj
BUCK'S, INC.
PACKAGE LIQUOR LICENSE APPLICATION FOR
BUCK'S, INC 5718 NORTHWEST RADIAL HIGHWAY 68104
DBA BUCKY'S EXPRESS
MANAGER'S APPLICATIONS FOR THE FOLLOWING PACKAGE LIQUOR LICENSED LOCATIONS
BUCK'S, INC 10202 MAPLE STREET 68134
DBA BUCKY'S EXPRESS#12
BUCK'S INC 2765 SOUTH 13TH COURT 68108
DBA BUCKY'S EXPRESS#13
BUCK'S, INC 4805 SOUTH 108TH STREET 68127
DBA BUCKY'S EXPRESS#18
BUCK'S, INC 2510 SOUTH 132ND STREET 68144
DBA BUCKY'S EXPRESS#20
BUCK'S, INC 101 NORTH 30TH STREET 68131
DBA BUCKY'S EXPRESS#30
BUCK'S INC 3909 NORTH 132ND STREET 68164
DBA BUCKY'S EXPRESS#32
BUCK'S INC 13736 Q STREET 68137
DBA BUCKY'S EXPRESS#38
BUCK'S, INC 107 SOUTH 40TH ST 68131
DBA BUCKY'S EXPRESS#40
BUCK'S, INC 3435 SOUTH 42ND STREET 68105
DBA BUCKY'S EXPRESS#42
BUCK'S, INC 6003 CENTER STREET 68106
DBA BUCKY'S EXPRESS#60
BUCK'S, INC 2635 SOUTH 160TH STREET 68130
DBA BUCKY'S EXPRESS#61
BUCK'S, INC. 2901 NORTH 72ND STREET 68134
DBA BUCKY'S EXPRESS#72
BUCKS, INC. 3052 SOUTH 84TH STREET 68124
DBA BUCKY'S EXPRESS#84
BUCKS, INC. 9645 IDA STREET 68122
DBA BUCKY'S EXPRESS#96
BUCK'S, INC 4414 NORTH 30TH STREET 68111
DBA BUCKY'S EXPRESS 831
MANAGER'S APPLICATION FOR THE FOLLOWING OFF SALE BEER LICENSED LOCATION
BUCK'S, INC. 2223 SO 24TH ST 68108
DBA BUCKY'S EXPRESS #24
No.
Buck's, Inc., dba "Bucky's Express #12",
10202 Maple Street, requests permission to
appoint Robert J. Diesing manager of their
present Package Liquor License location.
06-09-15;cj
eO
RECEIVED
Presented to Council:
June 9, 2015 - Approved 9-
Buster Brown
City Clerk
3