RES 2015-0666 - Appoint Robert J Diesing manager of Bucky's Express #20 1NE AT4T by
ED
., - . l C ice.. 1 �Y
STATE OF NEBRASKA
'"' V",
< a 3 Pete Ricketts t� NEBRASKA LIQUOR CONTROL COMMISSION
V ' l e er 2015MAY 21 An 11`
Hobert H Rupe
etc *y��'��- Executive Director'
"` 301 Centennial Mall South,5th Floor
CITY CLERK P.o.B �so46
n 11 A i i t',, i E Es l�A S K A Lincoln.Nebraska 68509-5046
Phone(402)471-2571
Fax(402)4 71'•2814 or(402)471.2374
-FRS USER 800 833-7352(TTY)
May 20, 2015 web address-http://i ww.lcc.ne.gov/
OMAHA CITY CLERK
1819 FARNAM STREET LC-1
OMAHA NE 68183
RE: Manager Applications Robert Diesing
LICENSE #D-70766, #D-53987, #D-72419, #D-69818
Dear Clerk:
Enclosed is a copy of a manager application for Robert J. Diesin•, in connection with the Bucky's
Express 12, Bucky's Express 13, Bucky's Express 18, and th . - dr>II 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,
rf
Jacqueline Rodriguez 7
Licensing Division
NEBRASKA LIQUOR CONTROL COMMISSION
402-471-2571
encl.
Janice M.Wiebusch Robert Batt Bruce Bailey
Cornrrrissioner
Chairman Commissioner
An Equal Opportunity Emplvyt r
!
1
MANAGER APPLICATION Office Use
INSERT-FORT%3c
REC IVED
NEBRASKA LIQUOR CONTROL COMMISSION
301 CEN1ENNIAL MALL SOUTH
APR I 0 2015
PO BOX 95046
LINCOLN,NE 68509-5046
PHONE:(402)471-2571
FAX (402)471-2814 t
WEBRA- KA 4100.18‘70,4
CONTROL CON., ,„... ,
Website:wwwAcc.ne.gov
MUST BEI
1 Citizen of the United States. Include cony of US birth certificate, naturalization paper or
current US Dassnort
1 Nebraska resident Include copy of voter registration in the State of Nebraska
1 Fingerprinted. See Form 147 for further information,this form MUST be included with your
application.
1 21 years of age or older
- ,,.:,,,,,,r„1 - -4,-k q,-,,I..Ie.;':.7",r'f..i., '''Tv? _ 77,,, 7.7,7:,: :,,,, 0.;..-.,',-,•„ . ,,,,A.•- ,
„ .- • t; ,--,',,-A...,,,,: ,__ , , -
Name of Corporation/LLC:Buck's Inc
(,,,cif./? D
Liquor License Number: 613484 Class Type of new application leave blank)
Premise Trade Name/DBA: Bucky's Express # 20
2510 S 132nd Street
Premise Street Address:
ouglas
City:Omaha County:Douglas Zip Code:68144
Premise Phone Nurriber:402 330 0190
Email address:bdiesing@buchananenergy.com
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 Commission. 1 k on this link to see authorized individuals.
httn://vvww.lcc.nceovilicense searchtlicsearch. i
, 1
i
SIGNATURE REQw11 r ' ?JO: Ott* -OFVI . ' IMIOIAG It- ''i 156
(Faxed signatures are acceptable)
Form 103
REV JAN 2015
Page 2 of 6
Last Name:Diesing First Name: Robert MI:
Home Address(include PO Box if applicable) 1005 E Aberdeen Drive
City: Sarpy 68046
City: County: Zip Code:
402 597 3172 402 558 9860
Home Phone Number: Business Phone Nurnber:
Social Security Number: Drivers License Number&State:
Date Of Birth: - - Place Of Birth:Omaha NE
diesing@buchananenergy.com Email address:b
R MED
•YES D No
NEBRASKA LIQUOR
CONTROL UVIVIIVI I
Spouses Last Name:Diesing
First Name:Sheri
MI:
Social Security Number: Drivers License Number& State:
- —
Date Of Birth: Place Of Birth:Omaha NE
CITY& STATE YEAR YEAR
CITY& STATE YEAR YEAR
FROM TO 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 TELII"HONE
FROM TO NUMBER
2011 2015 Buck' Inc Steve Kapple 402 558 9860
2007 2011 Premier Beverage Mark Wright 402 891 1212
l. 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, EV[R been convicted of or plead guilty to any c
Chargmeans
e
e
ens gay 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 m•; ,,. . � �please list
charges by each individuai's name. .. u
O YES D NO APR t 0 2015
if yes,please explain below or attach a separate page. NSBR ,
CkINTL COMMISSION
Date of Where Descrip on
Name of Applicant Conviction Convicted of Disposition
(mmiyyyy) (City&State) Charge
2. Have you or your spouse ever been approved or made application for a liquor license in Nebraska or
any other state?
OYES ONO
IF YES, list the name of the premise(s):
3. Do you,as a manager,qualify under Nebraska Liquor Control,Act(§S3-l3l.Ol)and do you intend to
supervise, in person,the management of the business?
•YES ONO
Farm 103
REV JAN-201S
Page 4 of 4
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 ofro
( YYYY) P (attach copy of course completion certificate)
Robert Diesing 04/2015 RBST Nebraska
*For list of NLCC Certified Training Programs see www.Icc.ne.gov/traininginfo.html
Experience: .
Applicant Name/Job Title Date of Employment: Name&Location of Business:
Robert Diesing/Beverage Category Manager Aug 2011 Buck's Inc 7315 Mercy Road Omaha Ne 68124
5. Have you enclosed Form 147 regarding fingerprints?
[]YES ONO
Form 103
REV JAN 2015
Page S of 6
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 back
ground 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.
RECEIVED
APR 1' 0 215
UOR
ign o anager Applicant Sig, :;M 0.1-le ,.fie. CO ISSION
ACKNOWLEDGEMENT
State of Nebraska
County of e v c l 5 The foregoing instrument was acknowledged before me this
! — 7 - ,a ff i by a s k+1
date
name of person acknowledged
Affix
scat Gm
BAI ha?TAR`-state bf BNetxaska
Notary blic signature I' tEr� �o �
My Comm.exc.!,larch 10,?MI
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 3015
Page 6 of 6
.......4.4.-
SPOUSAL AFFIDAVIT OF
officv use
RECEIVED
NON PARTICIPATION INSERT
.3Nor cRAENSTEKANNLIQIADLOMBALCOLNSOTRiOTLHCOMMISSION
PO BOX 95046
ft NS
LINCOLN,NE 68509-5046
PHONE (402)471-2571
FAX (402)471-2814 APR 1
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Sheri Diesing
- '
Printed name of spouse asking
listed below)
Signature of spouse asking for waiver for waiver
(Spouse of individual
Nebraska
State of
Douglas
County of sThnene Diesing
by
foregoing instrument was acknowledged before me this
April 7 2015
date acknowledged
name of person
Affix Seal
MARY State of arla
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Notary Public Si ature
my corm Eee2Z_
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Robert Diesing
Signature of ind vidual involvbeodv):Zpe;
(Spouse of individual listed a application Printed name of applying individual
Nebraska
State of
Douglas
County of RobertThDeiesfoirneg
by
foregoing instrument was acknowledged before me this
April 7 2015
date name of person acknowledged
r:rt.L6' Affix Seal
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in other formats for persons with In complianceFORM 35-4178
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Revised 1/2008
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City ofOmaha, f1[eBrasAa oM�HA N
1819 Farnam —Suite LC 1 "VC! L`Omaha, Nebraska 68183-0112 2 ;._�� l
Buster Brown 402 444-5550 ��'� � � " �'
City Clerk ( } "O _-
FAX (402) 444-5263 r) - '- �4
9rFD FE130%.
May 26, 2015
Buck's, Inc. Application to appoint Robert J. Diesing
Dba"Bucky's Express #20" manager of your present Package Liquor
2510 South 132nd Street Liquor License location
Omaha, NE 68144
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,
e‘ei,40:11.2
Buster Brown
City Clerk
BJB:clj
City of Omaftq, Nebraska ,, 4,
OMAHA N
1819 Farnam — Suite LC 1 -- r` - I)
Omaha, Nebraska 681 83-01 1 2 nWr r'�Of
Buster Brown 0' `
06
City Clerk FAX (402) 444-5263 ' 04,4
FO FEBRUts.
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,
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
BUCK'S, INC. 3052 SOUTH 84TH STREET 68124
DBA BUCKY'S EXPRESS#84
BUCK'S, 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. 6&
Buck's, Inc., dba "Bucky's Express #20", 2510
South 132nd Street, requests permission to
appoint Robert J. Diesing manager of their
present Package Liquor License location.
06-09-15;cj
RECEIVED
Presented to Council:
June 9, 2015 - Approved -U
Buster Brown
City Clerk
2