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RES 2015-0676 - Appoint Robert J Diesing manager of Bucky's Express #96 Kt rE$� �— -,E r� Pa �., (.' L I V t.s- , " .4. .,`. STALE. OF NEBRASKA a 1, K `', P Ricketts 2815 MA Y 21 AM 1 : 56 NEB SIt,a.LIQUOR CONTROL'C�ssioN c ` "' '':' Governor Hobert B.-Rope 'u y c.K EZcectitlue I`irector + . C 301 Centennial Mall South,5th.Floor PO.Boy:95046 n M:A fi A. N i=B R A S K n, lincolrt,Nebraska 6850 -5046 Phone(402)471.2571 Fax(402)471-2814 or(402)471-2374 IRS USER 800 833-7352(1TY) web address:;http://w w.lcc,rte.gov/ May 21, 2015 OMAHA CITY CLERK 1819 FARNAM STREET LC-1 OMAHA NE 68183 RE: Manager Applications Robert J. Diesing LICENSE#D-49118, #D-97146 -94806, #D-84428 Dear Clerk: Enclosed is a copy of a manager a plication for Robert J. Diesing, in connection with the Bucky`s Express 72, Bucky's Express 831 ucky`s'xpress 9 and the Bucky's Express 84, all located in Omaha. Please present this application for manager to your City/Village Council or County Commissionersand send us the results of their action. Sincerely, Jacqueline Rodriguez a Licensing Division NEBRASKA LIQUOR CONTROL COMMISSION" 402-471-2571 encl. i Janice M.Wiebeech Robert Batt Bruce Bailey Coi„,,,issioner Charrmon Corrinitssioner Art Equal Opportunity Erriployer ' h MANAGER APPLICATION Office Use INSERT-FORM 3c NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH PO BOX 95046 LINCOLN,NE 68509-5046 PHONE:(402)471-2571 FAX:(402)47I-28I4 Website:www,Icc.ne.coi MUST BE: ✓ Citizen of the United States. Include cony of US birth certificate, naturalization paper or current US passport ✓ Nebraska resident Include cope of voter reeistration 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 Liquor License Number: 94806 Class Type© (if new application teav 'sank) Premise Trade NamefDBA:Bucky's Express # 96 Premise Street Address:9645 Ida Street City:Omaha County:Douglas 68122 Zip Code: Premise Phone Number:402 573 6210 Email address:bdiesing@buchananenergy.com RECEivED APR The individual whose name is listed as a corporate officer or managing menu* s reported on insert form 3a or 3h or listed with the Commission. Click on t Eiirk individuals. httn:ffwww.kc.ne-aovilicense search/licsearch. CONTROL COMMISSION (Faxed signa s are acceptable) Fw c 103 REV JAll 2015 PagO2 of6 LastNye:CDlesrng Robert 1 First Name: MI: Home Address(include PO Box if applicable): 1005 Aberdeen Drive City:Papi for County:Sarpy zip Code:68046 Home Phone Number:40' 597 317 Business Phone Number:402 558 9860 Social Security Number: Drivers License Number&State:ODate maha NE Of Birth: - . - — . Place Of Birth: Email address:bdiesirig@t)ucharianerlergy.com Q YES Q NO Spouses Last Nellie:DIeSing F rst P+lame:`" heri MI: Social Security Number: Drivers License Number&State: — - -- Date Of Birth: Place Of Birth:Omaha NE CITY& STATES 17EEAR CITY&STATE PEAR YE t FROM TO FROM TO ?opinion NE 1998 2015 ?opinion NE 1998 2015 NEC APR l fl Z[3 t4EBRAsKA LIQUOR CONTROL CO MISSION' fccm�3 REV JAN 2b15 Pasts 46 i r. YEAR NAME OF EMPLOYER NAME OF SUPERVISOR ' TELEPHONE FROM TO NUMBER 2011 2015 Buck' i nc Steve Kapple 402 558 98f 0 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, gVER been convicted of or plead guilty to anyCharge means my 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 rthe conviction or plea. Also list any charges pending at the tune 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 ' Name of Applicant Conviction Convicted of Disposition (mmyyyy) (City&State) Charge RECEIVPD 2. Have you or your spouse ever been approved or appli + .Ye- •APR,:. any other state? `oo t D i5tillseSs}iRr Nebraak4, or DYES [ENE) 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 in to supervise,in person,the management of the business? AYES O F l03 REV I I5 Page et‘ 4. '' List the alcohol relate,d training and/or experience(when and where)of the person maid,g application. *NLCC Training Certificate Issued: RBST Name on Certificate: R►Q �'t esirig Applicant Name Date Name of ( ,) program(attach copy of course completion certificate) Robert Diesing 04/2015 RBST Nebraska 7 *For list of NLCC Certified Training Programs see wwv►.ice.ne.gavttrainingnnfo.lhtrnl Experience: Applicant Name/Job Title Date of Name&Location of Business: Employment: Robert Diestig.tame CattegOtY Marnager Aug 2011 Buck's Inc 7315 Mercy Road Omaha Ne 68124 5. Have you enclosed Form 147 regarding fingerprints? API? 1021 31YES ONO {3NOL QQ,MISc Fotiril 103 REV JAN,2015 Page,of 1 The above individuals beingfirst dulysworn individual(s), upon oath, deposes and states that the undersigned is he 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. Signs e c Manager Applicant Sri. gnature of Spouse REne IVED ACKNOWLEDGEMENT APR I 0 2015 State of Nebraska I. 1ERA Li County of tv l e.5 The foregoing i a a .'"1 I O.O. e this by tes1K date name of person anknoadedgea Affix Seal NOW)/Pu is signature TA4Cl L NNF 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 JANp15 Page d of 6 tIE a 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: wyw.lce ne,gov x E G .;„ E :l Y i 7 d� i SY €'9 i. t 6 4`NSa 4 7 3 I - q Pt '�'af 6 d R {�k� ti r " -4`" > 'mow i w" Sheri Diesing Signature of spouse asking for waiver Printed name of spouse asking for waiver (Spouse of individual listed below) Nebraska State of County of Douglas The foregoing instrument was acknowledged before me this April 7015- by Sheri Diesing datename of person acknowledged Affix Seal Notary Public signature LEEANN F NOBLE XERAL Nt1fitY 5t ttxasltaMay Comm.Exp.Marts 10,2017 {i k 3,Ba9a. a 'ts # r e s� f t a r s� � �ri 1'4�.• d• Dies',„ Signature of i dividual involved with application Printed name of applying individual (Spouse of individual listed above) APR i o 2,015 State of Nebraska Douglas � � 3C County of. The fore �l` nKA , fio��,e ged before me this April 7 2015 by Robert Diesing mQ name of person acknowledged Affix Seal Notary Public Sign GENERAL NOTARY-State ct*boatel EEEANN F NOBLE _ My CommEap,Match 10 2017 In compliance with The ADA,this spousal affidavit of non participation is available in other formats for persons with disabilities. A ten day advance period is requested in writing to produce the alternate format. FORM; 178 Revised L(200E • cam g RECEIVED 0� L� APR x 2015• •• Li (2 7 NEBRASKA LIQUOR 1 .> i1 r: - •CoNTRQL QOMMISSiC i1[. �� } u ,)cw .... ,..,...• ,• �-� �� 4 o Lam :}, 1 it N o ;,•'i f • n � co• 69 L7 % , a',"bil A) ,4 V _• � T..".L � u : - `- ''":rr .� � , -- --c--�-c� '��= 'c_c ' � � m C rn fD c� � o a, _ . `: m m m fD z RECEIVED w c APR I 0 2015 R - .rt NEBRASKA LIQUO 7•1. CONTROL COMMISSION • "" '"r } V � b k City of Omaha 9VebrasAa � J 9 7 altar:;ioN)ar-'.4%1819 Farnam — Suite LC 1 �' Omaha, Nebraska 681 83-01 1 2 �v r'l ii! ,,, Buster Brown 0''4 e4' ' .N"- (402) 444-5550 �'.4 _ :_ tv City Clerk FAX (402) 444-5263 o 9TED FE130' May 26, 2015 Buck's, Inc. Application to appoint Robert J. Diesing Dba"Bucky's Express #96" manager of your present Package 9645 Ida Street Liquor License location Omaha, NE 68122 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. Sincer y yours, C6' %Pe'. ••° Buster Brown City Clerk BJB:clj Ci ofOmaha Webra4a ,44, - ,-itp (:)-41 ,......,0410, OMAH9 N '��rr !d. 1819 Farnam — Suite LC 1 j4 t.1 'rr1 gag Omaha, Nebraska 681 83-01 1 2 ng , Plr '�l .) ckli Buster Brown 402 444-5550 ��'�•_ '` { `,'47• City Clerk ( ) re` "_:., FAX (402) 444-5263 0� =`� '{"- �� 94 FE130' 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, 41.440,9,40L.,,,,- _ 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 BUCKS, INC 10202 MAPLE STREET 68134 DBA BUCKY'S EXPRESS#12 BUCKS 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. Buck's, Inc., dba "Bucky's Express #96", 9645 Ida 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 7-o Buster Brown City Clerk