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RES 2015-0668 - Appoint Robert J Diesing manager of Bucky's Express #32 , STATE OF NEBRASKA 2015 MAHNEBRASKA LIQUOR CONTROL COMMISSKON ti, n{ , �; Pete Ricketts I b -• " Governor Hobert B.Rupe ' Executive Director tgkcsi 301 Centennial Mall South.5th.Floor CITY CLERK P.o.Box 95046 Lincoln,'Nebraska:68509-5046 �,#, i1. S i� Phone(402)471-2571 Fax(402)471-2814 al(402)471-2374 TRS USER 800 833-7352 11 1 Y) web address:http://www.lcc.ne.gov/ May 20, 2015 OMAHA CITY CLERK 1819 FARNAM STREET LC-1 OMAHA NE 68183 RE: Manager Applications Robert J. Diesing LICENSE #8-28729, #D-65591, -4 245, 8t#D-103283 Dear Clerk: Enclosed is a copy of a manager application for Robert J.Diesing, in connection with the Bucky's Express 24, Bucky's Express 30, uc s xpress nd the Bucky's Express 38, ail 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, t ... (� Jacqueline Rodriguez Licensing Division NEBRASKA LIQUOR CONTROL COMMISSION 402-471-2571 end. • Janice M.Wiebuseb Robert Batt Bruce Bailey Commissioner Chair,rrun Commissioner An Equal Opportunity Erna/ayer MANAGER APPLICATNO►N office case INSERT-FORM 3c NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH PO BOX 95046 LINCOLN,NE 68509-5046 PHONE:(402)471-2571 FAX:(402)471-2814 Website:wwu.tce„ne.gov MUST BE: ✓ 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 Name of Corporation/LLC:Buck's Inc ....amil n.m.s: .. .;-......:,. .. D Liquor License Number: 47245 Class Type REEC blank) Premise Trade Name/DBA:BUCky'S Express # APR 10 2015 Premise Street Address:309 2nd Street NEBRASKA LIC111t R Omaha Douglas CONTROL Cg114 City: County: Zip Code: Premise Phone Number:402 431 1717 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. Ci'ck on this link to see authorized individuals. http://ww'w.lcc.ne.aovflicense search/licsearch.cEi (Faxed signatures area ceptable) Form 103 REV JAN 200 Page 2 of Last Name:Diesing First Name:Robert MI:`'i Home Address(include PO Box if applicable):1005 E Aberdeen Drive city:Papillon County:Sarpy' zip Co :68046 Home Phone Number,402 597 172 Business Phone Number:40 558 9860 Social Security Number: - Drivers License Number&State: NE Date Of Birth: - Place Of Birth:Omaha Email add:bdiesing@buchananenergy.com s m.MREC •i YES NO APR .10 2015 tiE Spouses Last Name:� '$il"1g First Name:Shtefi MI: Social Security Number: _ _ _ _ _ _ Drivers License Number&State: Date Of Birth: - - - - Place Of Birth:{ tnaha NE CITY&STATE YEAR YEAR CITY&STATEYEAR YEAR FROM TO FROM TO Papillion NE 1998 2015 Papillion NE 1998 2015 Fora 103 REV JAN 2015 Pac3of6 YEAR TELEPHONE NAME FROM TO `OF EMPLOYER NAME OF SUPERVISOR 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 means ally 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 tuft #,, .aF t 'lease list charges by each individual's name. YES 0 N4APR I } � 5 NEBRA K If yes,please explain below or attach a separate page. LIQUOR CONTROL •l Ml Date of Where Description Name of Applicant Conviction Convicted of Disposition (mm/yyyy) (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 VINO IF YES, list the name of the premise(s): 3. Do you, as a manager,qualify under Nebraska Liquor Control Act(§53-131.01)and do you intend to supervise,in person,the management of the business? DYES ONO Form 103 REV JAN 2015 Page 4oft 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. { ert Diesing Date Applicant Name ( yy) Name of program(attach copy of course completion certificate) Robert Diesing 04/2015 RBST Nebraska *For list of NLCC Certified Training Pmgranis see www.lcc ne.s• 14 it+e Experience: APR 10 2015 Date of Applicant Name/Job Title Name&Location sit iness: Employment NFBRASKA LIQUOR' Robert Diesing/Beverage category Manager Aug 2011 Buck's Inc ck to _ o. ',. t;,3 : ., s c 68124 5. Have you enclosed Form 147 regarding fingerprints? [IYES ONO =- Form 103 REV JAN2015 Page 5 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 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 acorn lete, inaccurate, or fraudulent RECEIVED APR 1,0 2015 Signature of onager Applicant e ACKNOWLEDGEMENT State of Nebraska County of U i I At S The foregoing instrument was acknowledged before me this —? - ad Sn by ✓'1' t/IesatAg date name of person acknowledged Affix _., litaxaski GEKBALtQ ARV-5tat of Notary bile signature a1rt Foa1.E . - MY Comm ExP.March 1D,21Z 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 4 ",,,-- 4.S4.li,'4 SPOUSAL AFFIDAVIT OF Office Use NON PARTICIPATION INSERT NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH PO BOX 95046 LINCOLN,NE 68509-5046 PHONE.(402)471-2571 FAX (402)471-2814 Website: www lee ne gov . � € , i l a� a € €a a I o 1 a"' i i ,, " yxi - >€ azis t s 7. ,, a a tx -,� c F a :40 n m 44317 a rr ` adxa� � � $ �,<d �S s 9 g.., ,- al ¢ n - s a + t 2i ' fa` a > tL: t� 9 s a 4 k,.-a > -t zz'€ €c si - as-^ �R1s7 s '€ t €x e a s n 4 •. a .,fei € s tt� a .r d � ,e ag 9d� a.� a,, st � i u�. .8 a s t � �( i � '_r;� ^ :�*^ w . ems€ =`-;e;:a.. '-".ry �;; �'_� �.am,YM� a�?�,P a. �.t�..; d t n .' Sheri Diesing Signature of spouse asking for waive Printed name of sp ver (Spouse of individual listed below) State ofNebraska APR 1 0 at)15 County of Douglas The foregoing instrum -;7;,7-'.r a. ; adPale me this Apra 7 2015 by SheriDiesing l 1 OMMI r / f)--)2.«.. LA, date name of person acknowledged Affix Seal jetiGEtER41..NOTARY-State of titmice Notary Public sip&ure LEEANN F NOBLE My Comm Exp,Mardi 10,2017 Y>4c , as €a 4. pi t� n i€ its r a ''' a le',a4--, a r " ° a h, ',.` , /. F ra €l a r. :raaa M 4 4, r , � _ , ^ m Robert Diesing Signature of' dividual involved with application Printed name of applying individual (Spouse of individual listed above) Nebraska State of Douglas County of The foregoing instrument was acknowledged before me this April 7 2015 b Robert Diesing date y name of person acknowledged if...14.---",1.1 / d Affix Seal TJt Notary Public sign NOTARY-State of trasita jttalfNERAL LEEANN F NOBLE My Comm E p.March 10,2017 In compliance with the ADA,this spousal affidavit of non participation is available to other formats for persons with disabilities A ten day advance period is requested in writing to produce the alternate format. FORM 35.4178 Revised 1J2688 I R t` -, \ N. \ \ .\ \ \ N. \ \ \ \ \ \ \} s . . s R •ECEIVED H '• ..' '. -::' •'. 1 �l APR 1'02015 tfl - NEBRASKA LIQUOR l-) _ CONTROL QOMMISSIC N `� lny. ._ . = _ rn o cp N x _• 4. • r� © �. . . N FA iii Di . . o o ° 4`.a • -' i i . — m • . - - .A b - op_ . ;ii 1. . . z . . k ' . • ,.,, —1 . .• . -. L i - _ S co . t ; � r� . . . 0 ,i-.3 - „., -. .5: --. - c7 . ' - - • - till r - . "...7:: -/"") - • - - - . . f1t �f w� %1tz B / � a. - . - \ ‘' sr 4 'G'"'G'- ' GEC' • 1133 CO m CC nZ CD CD a _ • r� {D c 69 • Tm1 rt W.. • • • RECEIVED 8 APR 1 0 2015 = .: NEBRASKA UQUOR "itCONTROL"COMMISSION $ y • • • 2 k • • City o Omaha LebraskiaOMAHA, N/ 4) 1819 Farnam —Suite LC 1 � fi � ^ikj Omaha, Nebraska 681 83-01 1 2 rz, r '^ Buster Brown (402) 444-5550 ,o ; � ti City Clerk FAX (402) 444-5263 Oq ' 4� TFD FEB170 May 26, 2015 Buck's, Inc. Application to appoint Robert J. Diesing Dba"Bucky's Express#32" manager of your present Package Liquor 3909 North l32nd Street Liquor License location Omaha,NE 68164 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 N1AHA CiiyofOmali4, Wjbras a 04° ,,N� 1819 Farnam — Suite LC 1 'r Ri i 4 ,, Omaha, Nebraska 681 83-01 1 2 n r'-_r'1 'g Buster Brown (402) 444-5550 � ti City Clerk FAX (402) 444-5263 o.4)9FD FEBRt.*4� 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 BUCKS, 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 BUCKS, 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 BUCKS, 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 #32", 3909 North 132nd Street, requests permission to appoint Robert J. Diesing manager of their present Package Liquor License location. 06-09-15;cj j RECEIVED Presented to Council: June 9, 2015 - Approved 7-e' Buster Brown City Clerk