RES 2015-0254 - Appoint Carol M Enke manager of Fox Hollow Coffee t.
- STATE OF NERASKA
,,..� 7 Dave Heineman 20 —9 � 7 ERRRASKA LIQUOR CONTROL COMMISSION
**` .,„ Governor Hobert B.Rape
lit,,,,.. .„
Executive Thrector
'' lam:'x° _
CITY CLERK 3°1Centennial
Mall PS.O.8otttl,,oSthx9504 Floor
CM.a f?A. N E B R A S K a Lincoln,Nebraska 68509-5046
Phone(402)471-2571
Fax(402)471-2814 or(402)471-2374
February2015 TRS USER Soo$33-7352(TTY)
6, web address.http://www.kc.ne.gov/
OMAHA CITY CLERK
1819 FARNAM STREET LC-1
OMAHA NE 68183
RE: Manager Application Carol Enke
LICENSE C-97600
Dear Clerk:
Enclosed is a copy of a manager application for Carol Enke, in connection with Fox Hollow Coffee
located in Omaha.
Please present this application for manager to your CityNillage Council or County Commissioners and
send us the results of their action.
Sincerely,
Jacqueline Rodriguez
Licensing Division
NEBRASKA LIQUOR CONTROL COMMISSION
402-471-2571
end.
Janice M.Wiebusch Robert Batt William F.Austin
Commissioner Chairmen Commissioner
An Equal Opportunity Employer
Panted with soy ink on recycled paper
MANAGER APPLICATION
Mee uflOISSMIA100 1081N00
INSERT-FORM 3e
):Ionon ymsvtioaN
NEBRASKA LIQUOR CONTROL COMMISSION
301 CENTENNIAL MALL SOUTH SWZ Z 0 833
PO BOX 95046
LINCOLN,NE 68509,5046
PHONE (402)471-2571 GRA13038
FAX:(402)471-2814
Website:www.Ice.ne.gov
MUST BE:
1 Citizen of the United States. Include coin of US birth certificate,naturalization paper or
current US passport
1 Nebraska resident. Include cop v of voter registration in the State of Nebraska
I Fingerprinted.Two cards per person,fees of$38 per person,made payable to Nebraska State
Patrol. If printed at NSP mail check only. Cat-retc mitrlei 61/ 4/6 S,1,1221-6. /4042//
I 21 years of age or older /34-ym tizt de 0,7/
• ‘4 '‘ • , r] • •
Name of Corporation/LLC: NO(4-11 Wood-5 C04ee- orrw et-tNy
Liquor License Number: q 76a 0 Class Type a
(if new application leave blank)
Premise Trade Name/DBA: ' ;.)( 4-0
Premise Street Address: I Pc&e10 r Pk.w in 31
City. Owo.k& County: 1)00.5 t Ck.,c Zip Code:
Premise Phone Number: Lioa qct I -Li 3 3 0
Email address: ce_vi 1, e cx
The individual whose name is listed as a corporate officer or managing member as reported on insert
form 3a or 3b or listed with the Commission. Click on this link to see authorized individuals.
http://www.lec.ne.govilicense search/lime h.c
SIGNATURE REQ D BY CORPORATE OFFICER I MANAGING MEMBER
(Faxed signatures are acceptable)
Form 103
— - -- — )12013
2 of 6
INN 111
1500000985
Last Name: 1�C - First Name: Gc..!"C7 MI:
Home Address(include 1'O Box ifapplicable): /79 f4 T!T
City: County; Do G Zip Code: to S Q
Home Phone Number: 9 89.c4'/G,3 Business Phone Number: 4' 2 99/ - ' 33L
�,
Social Security Number;_ _ -
Drivers License Number&State: _
f �
cj
Date Of Birth: �, _ Place Of Birth: + r GQ f L-"
Email address: l'',�n e Cole- ' h e
YES ❑NO
Spouses Last Name: En - First Name: let y > S 1VIl:
Social Security Number:_ _ _ _ _ Drivers License Number& State: _ /
Date Of Birth: r ! Place Of Birth: y f e�` /
,". . ,5.'�•� � � � �Ri8 t" �, .� � �fx£ � tµ biz' ',��i�� t . � ..,.
YEAR YEAR YEAR YEAR ;
CITY& STATE CITY& STATE
FROM TO FROM. TO
glaital„ /!/i bvoc� aar. 1 ptesen !?in r ld /ffE Apo/ s .
j! Form 103
ev 9/2013
REEIVED
Page 3 of 6
F L3022015
NEBRAS q LIQUOR
CONTROL COMMISSION
h S
YEAR TELEPHONE
NAME OF EMPLOYER NAME OF SUPERVISOR
FROM TO iverfih,rdr x eotvea.,e0. mys .- NUMBER
"11/°g '^f l/aw 'tf e. - etrily Lie."."- 42 9/
1Q$ t !'9 ° 1 - 0 a
ADZ v
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.
❑ YES NO
If yes,please explain below or attach a separate page.
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?
)5ES ENO
IF YES,list the name of the re ise(s):
Fox 11 r W �v
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 ONO
RECEIVED Farm 103
Rev 9/2013
Page 4 of 6
FEB 02 2015
NEBRASKA LIQUOR
CONTROL COMMISSION
4. List the alcohol related training and/or experience(when and where)of the person making application.
*NLCC Training Certificate Issued: ilbq //R Name on Certificate: re/ 61ited
Date
Applicant Name Name of program(attach copy of course completion certificate)
(mm/YYYY)
0.4-eV / En k2r gf. 9/c // Re,5porko h 1e, e c 1-V!G.£.
' 17-sai n try
*For list of NLCC Certified Training Programs see www.Ice.ne.gov/traininginfothtml
Experience:
Applicant Name/Job Title Date of Name&Location of Business:
Emplo ment: ,
(1_ -rO1 gonkk itianag et V / 6/ f'/9/2, iJ// -r1 f bt)
5. Have you enclosed the required fingerprint cards and PROPER FEES with this application?
(Check or money order made payable to the Nebraska State Patrol for$38.00 per person)
YES ONO
/ '\ Form 103
Rev 9/2013
Page 5of6
RECEIVED
FEB 02 2015
NEBRASKA LIQUOR
CONTROL COMMISSION
Nelkictolia fique4 eentwi eitnntUoion
Amato tilio certificate to RECEIVE
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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.
--
�ature of a er Applicant Signature of Spouse
ACKNOW
LEDGEMENT
,i'f../4/-"e
ACKNOWLEDGEMENT
State Hof Nebraska-m u ' as
foregoing
g
Court of ThehCalvI
e instrument"' was acknowledged before me this
--3i VIM' rii 3 � 2 O ( J by i nYe)
v t date name of person aeknowledged
A4 Seal
otary Public signatureIENNE REDUN
1 General Notary
1 Stets of Ne m**
1 My Commission Expires Aug 20,2018
In compliance 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.
RECEIVED Form 103
Rev 9/2013
Page 6 of 6
FEB 0 2 2015
EBRASKA LIQUOR
CONTROL COMMISSION
SPOUSAL AFFIDAVIT OF office Use RECEIVED
NON PARTICIPATION INSERT
NEBRASKA LIQUOR CONTROL COMMISSION FEB 0 2 2015
301 CENTENNIAL MALL SOUTH
PO BOX 95046
LINCOLN,NE 68509-5046 NEBRASKA LIQUOR
PHONE:(442)471.2571 CONTROL COMMISSION
FAX(402)471-2814
Website. wv.v. cc re
I acknowledge that I ant the spouse of a liquor license h '. `* tpr bow:confirms-that i wili*st not have iiY
intent,fitly or indirectly in the operation or-prom oft bins(§53 ;1'3))of the Liquor Control Act. `I Will not
tend sales,serve patrons,stock shelves,write 0e*alga invoice ors represent'myself as,he r or in,any
int dayto da oneyaon
{is of this b y fl capacity.� I u lee rill not.
require;however,I am obligated to sign and disclose any information on all applications'needed to process this
application.
(-);_i a Ft.A32zA__ chety. les 4 , en ki.e._
Signature of spouse asking for waiver Printed name of spouse asking far waiver
(Spouse of1individual listed below)
State of Neb yet s k ,
County of bo 1 Ct.5 The foregoing instrument was acknowledged before me this
m 0 by `,,��.-...y... ,,,,,;_,,,j , .,,....,, ))011.1t4131Vek‘c--
rname of person acknowled .
Afiix I" ADRIENNE REDLIN I
N l' signature tieneralltagry ►
State m Nebraska 1
My commission Expires.Aug 20,2010
i am the spouse of the above listed individual. I understand that my spouse and I are responsible for
compliance ` h the conditions set out above. If it is determined that the above individual has violated( 53-125(13))the
Commission may cancel or revoke the liquor license.
Ili', ,, ''' i--ittatt,i_e_ dot.col Ill . ke -
Signature of indivi•ual involved with application Printed name of applying individual
(Spouse of individual listed above)
State ofUVrAs
County oftj 'AS The foregoing instrument was acknowledged before me this
1
��, i i a) "/ by ! v \ /11 l,t
da`I name of person acknowledged
d i ' / Affix Sear�►l. r �ala.. �._._ .�, ADRIENNE REOLIN 0
WY Notary Publ signature t General Notary
State of Nebraska
4 MY Commission Wires Aug zo Nil I
In compliance with ADA,this spousal affidavit of non participation is available in other formats for persons wit di a e
A ten day advance od is requested in writing to produce the alternate format.
FORM 35-4178
Revised moos
��MwHA, NF6
City ofOmaha, Webras&a �� 1I
1819 Farnam—Suite LC 1 2V arift.174;la
'`i��rC.��
Omaha, Nebraska 68183-0112 0.4 a->"." "!:,_ =f-
Buster Brown (402) 444-5550 A ti'
City Clerk FAX (402) 444-5263 04rkD FEBRvt►�`k
February 24, 2015
Northwoods Coffee Co., Inc. Application to appoint Carol M. Enke
Dba"Fox Hollow Coffee" manager of your present Class "C" Liquor
1919 Papillion Pkwy#103 Liquor License location
Omaha,NE 68154
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 March 10, 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-ly yours,
AO 4r
Buster Brown
City Clerk
BJB:clj
City of Omaha, Webras&a )Q i 1N64 P/
,� �_ 01
lej
1819 Farnam—Suite LC 1 W (r :�� 4
Omaha, Nebraska 68183-0112 0. 3;.M^"•" ,_
Buster Brown (402) 444-5550 PA
City Clerk FAX (402) 444-5263 0
R47Fo FEBRvv,4-
February 24, 2015
Carol M. Enke Application to be appointed manager of the
3845 South 179th Ten present Class "C" Liquor License location
Omaha, NE 68130 for Northwoods Coffee Co., Inc., dba"Fox
Hollow Coffee", 1919 Papillion Pkwy
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 March 10, 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
No. f J
Northwoods Coffee Company, Inc., dba "Fox
Hollow Coffee", 1919 Papillion Pkwy #103,
requests permission to appoint Carol M. Enke
manager of their present Class "C" Liquor
License location.
03-10-15;cj
v
RECEIVED
Presented to Council:
March 10, 2015 - Approved 7-0
Buster Brown
City Clerk