RES 2014-1514 - Appoint Matthew E Turner manager of Super Saver #20 C EIVED
,„ --
STATE OF NEBRASKA
C.40. 2014 NOV -6 NE3RINSKA LIQUOR CONTROL COMMISSION
• ;ow "i Dave Heineman
4",- Gocernor Hobert B. Rupe
-*='vs° Executive Director
301 Centennial Mall South,5th Floor
CITY CLERK P.O Box 95046
(31‘1 4 HA, NE8R4SItA Lincoln,Nebraska 68509-5046
Phone(402)471-2571
Fax(402)471-2814 or(402)471-2374
IRS USER 800 833-7352(TTY)
November 5, 2014
web address:http://www.lcc.negov/
OMAHA CITY CLERK
1819 FARNAM STREET LC-1
OMAHA NE 68183
RE: Manager Application Matthew E. Turner
LICENSE C-76794
Dear Clerk:
Enclosed is a copy of a manager application for Matthew E. Turner in connection with Super Saver
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,
Jacqueline Rodriguez
Licensing Division
NEBRASKA LIQUOR CONTROL COMMISSION
402-471-2571
encl.
Janice M.Wiebusch Robert Batt William F.Austin
Commissioner Chairman Commissioner
An Equat Opportunity Employer
Pr reed with soy Ink on recycled paper
MANAGER APPLICATION Office Use
INSERT-FORM 3c
NEBRASKA LIQUOR CONTROL COMMISSION
301 CENTENNIAL MALL SOUTH r' %`L£i§
PO BOX 95046
LINCOLN,NE 68509-5046
PHONE:(402)471-2571 '
FAX:(402)471-2814 Co
i) / {
Website:www.icane.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
I Fingerprinted. Two cards per person,fees of$38 per person, made payable to Nebraska State
Patrol.If printed at NSP mail check only.
1 21 years of age or older
Name of Corporation!LLC: B&R Stores, Inc.
Liquor License Number: 076794 Class Type C
(if new application leave blank)
Premise Trade Name/DBA:Super Saver #20
Premise Street Address:5710 S 144th Street
City: Omaha County:Douglas NE
Zip Code:
Premise Phone Number:402-895-6611
Email address: Ma' tX`> t� (-C'\
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.lcc.ne.gov/license search/licsearch.cgi
11
SI: ATE`' = F` �° D BY CORPOR ►TE OF 'iCER/MANAGING MEMBER
(Faxed signatures are acceptable)
Form 103
Rev 92013
Page 2 of 6
110
1400025329
P aWbi, „L, rtMeM*.ilt*P10,
Last Name: ---rviej (< First Name: MOrtikeW MI: E
Home Address(include PO Box if applicable): 1.5.3111 MeieEPrig 4-tA,
City: 0 nik4S County: UGIASZip Code: (Q(6 11(Q
Home Phone Number: qc,-2:-(a2 - qsti Business Phone Number: LICA—
Social Security Number: Drivers License Number& State
Date Of Birth: Place Of Birth:
_
— - "
Email address: rOk t -er(
0 YES 1NO
Spouses Last Name: First Name: MI:
Social Security Number: Drivers License Number& State:
Date Of Birth: Place Of Birth:
NIIf --$10.2114,101-2-7(gi7ON -'°":
YEAR YEAR YEAR CITY & STATE CITY & STATE YEAR
FROM TO FROM TO
CR-cte- 1\)C1toMico5
LIMA:41 NC' "Cco5- 7 0‘1
boo Af 2-cot
REcE1VED
Form 103
7 21);,.} Rev 92013
Page 3 of 6
NEBRA6KA LIQUOR
CONTROL cohirmssioN
ttio wt F ; � ,..•
YEAR NAME OF EMPLOYER NAMETELEPHONE
OF SUPERVISOR
FROM TONUMBER
2.co 2-l' 9- S—CDWE5 ke E6e /tir< LC i 2�- '. (5`Co(o/1
lobs 2 I 1-1)r KY 12W K` C. Lo 62
i. 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 g y charge alle in 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/ yyy) (City&State) Charge
Oct riztyA (,1 (trA c TADS alb u ,W
b ItOI Li 6 4''ETAAJ�
2. Have you or your spouse ever been approved or made application for a liquor Iicense in Nebraska or
any other state?
EYES NO
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?
�ES ENO �� r
Form 103
Rev 9/2013
2 d 2014 Page 4 of 6
To whom it may concern
The following criminal history information was not included on the
Corporate Manager's application for the present Class "C" Liquor
License location for B & R Stores, Inc., dba "Super Saver #10",
5710 South 144th Street for Matthew Turner
09-13 — Operating vehicle during suspension — not reinstated with
the State — fine & court cost.
Please forgive the oversight and thank you for your consideration.
Sincerely
Matthew Turner
4: List the alcohol related training and/or experience(when and where)of the person making application.
*NLCC Training Certificate Issued: Name on Certificate:
Date
Applicant Name (mm/YYYY) Name of program(attach copy of course completion certificate)
*For list of NLCC Certified Training Programs see www.lec.ne.gov/traininginfo.html
Experience:
Applicant Name/Job Title Date of Name&Location of Business:
Employment:
r\ICt3
CONQUoR
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)
DYES
[ INO
1417Y e:
Form 103
Rev 9/2013
Page 5 of 6
'PERS AL'O;A_.TH ANA CQ SETT • STIGAfiION ,:t
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.
Si nature of Manager Applicant Signature of Spouse
ACKNOWLEDGEMENT
State of Nebraskt
County of -bt N,\�1S The foregoing instrument was acknowledged before me this
D c ,'r'" }7 b\ A by \C'.a,dnC (D\
date \
name of person acknowledged
ix Seal .,..IIEAiI NOTARY-State o1 Nelrcatka
Notary Public signature ���������'`'` RACH t.LCOHEN
MyCVRm.�•NOwnWr14,201f
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 92013
Page 6 of 6
04OM.HA, 4, 4
Cityo Omaha, fI'lebraska
1819 Farnam—Suite LC 1 2tlw Milt) t
Omaha, Nebraska 68183-0112 o�r y �; ,�. �'
Buster Brown '
City Clerk (402) 444-5550 0
FAX (402) 444-5263 � +
7WD PEWS
November 25, 2014
B &R Stores, Inc. Application to appoint Matthew E. Turner
Dba"Super Saber#20" manager of your present Class "C"Liquor
5710 South 144th Street License location
Omaha, NE 68137
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 December 9, 2014 . 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,
A. el 4fetze,.
Buster Brown
City Clerk
BJB:clj
oW'HA, A,
City ofOmaha, We6raskg
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.e.
1819 Farnam—Suite LC 1 a E� .'� `t ^
Omaha, Nebraska 68183-0112 0
Buster Brown (402) 444-5550
City Clerk FAX (402) 444-5263 04''� �p,4A
Fp EEBR
November 25, 2014
Matthew E. Turner Application to be appointed manager of
15314 Meredith Avenue the present Class "C"Liquor License
Omaha,NE 68116 location for B & R Stores, Inc., dba
"Super Saver#20", 5710 South 144th
Street
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 December 9, 2014 . 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
e (/K
S
No. /S/V
B & R Stores, Inc., dba "Super Saver #20",
5710 South 144th Street, requests permission to
appoint Matthew E. Turner manager of their
present Class "C" Liquor License location.
12-09-14;cj
)
RECEIVED
Presented to Council:
December 9, 2014 -Approved 1_
Buster Brown
City Clerk