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RES 2014-0898 - Appoint Eric P McDonald manager of Kum & Go #369 �,�t1E ST9 r�\IIII STATE OF NEBRASKA ,rt..k' Dave Heineman NEBRASKA LIQUOR CONTROL COMMISSION 4y,,��,��- a Governor 0-41 ? i Hobert B. Rupe ' v �ab� � Executive Director 301 Centennial Mall South, 5th Floor P.O. Box 95046 Lincoln, Nebraska 68509-5046 Phone(402)471-2571 Fax(402)471-2814 or(402)471-2374 TRS USER 800 833-7352(TTY) June 9, 2014 web address:http://www.lcc.ne.gov/ OMAHA CITY CLERK 1819 FARNAM STREET LC-1 OMAHA NE 68183 RE: Manager Application Eric McDonald LICENSE #D-47280, #D-78081, #D-81772 #D-8385 #D-97931 Dear Clerk: Enclosed is a copy of a mana er application for Eric McDonald in connection with the Kum & Go stores #372, #371, #368, 69, nd #36, all 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 Equal Opportunity Employer Printed with soy ink on recycled paper MANAGER APPLICATION Office Use INSERT - FORM 3c RECEIVED NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH RECEIVED PO BOX 95046 MAR 24 2014 LINCOLN,NE 68509-5046 PHONE:(402)471-2571 JUN 9 2Ui- NEBRASKA LIQUOR FAX:(402)471-2814 Website: www.lcc.ne.gov NEBRASKA LIQUOR 00 °I • x' MUST BE: CONTROL COMMISSION ✓ 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. Two cards per person, fees of$38 per person, made payable to Nebraska State Patrol. If printed at NSP mail check only. ✓ 21 years of age or older !,410: 'S1 x L a� '� t 3Py...�?» $ ' ... ..� '%.�':: fr A ''r' Name of Corporation/LLC: Kum & Go LC RECEIVED g� } 4 ,„Y u r°a Liquor License Number:83819 Class Type D NEBRASKA LIQUOR (if new application leave blank) CONTROL COMMISSION Premise Trade Name/DBA: Kum & Go # 369 Premise Street Address: 1 1 1 1 1 Emmet St City:Omaha County: Douglas Zip Code:68164 Premise Phone Number:402-933-3105 Email address: Licenses@kumandgo.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. Click on this link to see authorized individuals. http://www.lcc.ne.gov/1. e se search/licsearch.cgi SIGNATURE REQU Y C RPORATE 'FICER /MANAGING° EMBER (Faxed signatures are acceptable) Form 103 Rev 9/2013 Page 2 of 6 Last Name: Alc.nandict First Name: [/4', MI: Home Address (include PO Box if applicable): 9370 Wes-it/4 Avec ifl ` cif City: Qry ,t,,, County: a 1,3tct, Zip Code: ,vjc, Home Phone Number: 5i 5 3Q(D 7710 Business Phone Number: it et Social Security Number: _ Drivers License Number& Sty 2 1/ Date Of Birth: Place Of Birth: ��S /�+e�,yN S 4 204 74 Email address: EF/✓I 'Oi 0 o 4JQ/, ; Pi5Cr 4-C: , n k �.. ,.ewe-� .1�. � . -..c OYES ❑NO Lr A Spouses Last Name: /✓ic,andc-1 First Name: 7r i- MI: Social Security Number:_ 'i T _ Drivers License Number& State: , Date Of Birth: .' Place Of Birth: M( p1) ci tk CITY & STATE YEAR YEAR CITY& STATE YEAR YEAR FROM p TO '! / FROM TO r O WPM fv i f1Stn`/ Q/Ayd.„,, / t lac 2 nG ar1it(An l Ji4 -20 it .1c)l3 I f_"1/LAv �/ooa( ( d,./. , .2 1 /0J RECEIVED f i JUN 9 2014 .14 7nr` Q`T NEBRASKA LIQUOR CONTROL COMMISSION Form 103 Rev 9/2013 Page 3 of 6 P 0:>2 a v5 ( �5 F *q. s;' n.... .� .� z��u,.. .� ,-: t� ,-� 04 , 5 3 L�� '� } ° r«,.. ? YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE FROM TO NUMBER Q0 7 Ail c clalt 7; V«471a /9/cSG4` 1-. 1 79°Q .28°6 )007 /4/4,(.. . -6414 KAI;k Ho1 c 4 tiot 5/ 77I ' �7% 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 occurre a ear and month of the conviction or plea. Also list any charges pending at the time of this application. I��V y, please list charges by each individual's name. ❑ YES K. NO MAR 2 4 2014 NEBRIf yes,please explain below or attach a separatepage. CON o LIQUOR � ,� 00 Cam Date of Where Description Name of Applicant Conviction Convicted of Disposition (mm/yyyy) (City& State) Charge RECEIVED JUN 9 2014 NEBRASKA LIQUOR CONTROL COMMISSION 2. Have you or your spouse ever been approved or made application for a liquor license in Nebraska or any other state? OYES KNO 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? EYES LINO Form 103 Rev 9/2013 Page 4 of 6 4. List the alcohol related training and/or experience(when and where)of the person making application. *NLCC Training Certificate Issued: ..L. fri yal Name on Certificate: Applicant Name Date (mm/yyyy) Name of program(attach copy of courseefi t ertificate) Vd° LS-GA aL/pop K rt, 4149 oN7;9, — *For list of NLCC Certified Training Programs see www.lcc.ne.gov/traininginfo.html Experience: Applicant Name/Job Title Date of Employment: Name& Location of Business: (1 c, /4(1)., / l/vm ,+Go At/J. �o C 4 S�'1 0, ,R, Z4 I 4 64 l 4t� 2cel (.10%4a Ka,- /'�� )n (I AL, 14 a, .2o wi.44o /'Ji= Kam., -e G RECEIVED JUN 9 2014 NEBRASKA LIQUOR CONTROL COMMISSION 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) fYES ( NO Form 103 Rev 9/2013 Page 5 of 6 � _tp�, ({ zvb 5 �,,,��SSS� €€� #/� F9� 6 F V' �49 G� �u 5, yF.S G2 ' 'c o 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. teijE.cEI 41?24, Signature of Manager Applicant Si p j tis- ��4 AtA��, Nr Q uniti L c0 (�QUoR issIoA ACKNOWLEDGEMENT State of Nebraska County of IDDi The foregoing instrument was acknowledged before me this 1.24 — aov.i date by M1 RC1 LLE 1 I->�',Yf�Y�1A name of person acknowledged /71 Affix Seal ry?ublic signature GENERAL NOTARY-State of Nebraska MIREILLE M TAYAWA wle. MY Comm.Exp.ApxU 12,2017 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. RECEIVED J U N 9 2014 Form 103 Rev 9/2013 NEBRASKA LIQUOR Page 6of6 CONTROL COMMISSION Orli SPOUSAL�tle�Inta►vit�r air ---- *ON PAWl'ICIPATION INSERT (Moe iJ.r i ifstteui A Lsmott LY*(1 tof..CC MM$SNICJN X,/C'BNIf'k#TOIlAk,MALL 304/11h f'O tY)*SS{µd Mahn:OW)4114Si i +SAX'-(+1a2) 7i.,211,I4 I•ROkbowiecrifie WO 1 ten the spotaae'of a,t tter license haler, My aigl attkt�u below osnahme that I will have no have et *tercet.dirootty or .treetty in the C►t�otstat profit of the business(§53-125(13)).i or this Liquor Control Act. I will i terns Aar.'make set**,sterVe patrons,stook shealves,wane vL►arlkx,sign invoices or rep»t myself as the owner or to ati way ici**pate in lea day to day operations ofttth bustrabWslitany cap�*trity.. I understand my fingerprint wilt not be requited;iisittion. grated to sign*sd disclose I I1) if ►tioot'oe au all iustSonki londoat tO prvt3aals this ` nnettor unc ss}cx 4r vveivee ' —___.-___, 1r-l iaarrtrs `Wei Ver.."_�,_. (Spouse o ndividuatl listed below) County of ?o t The% —_, fettofitJt instrument wits acknowledged before rue I ,I, _ _.err- , is - �?^! arils >a irl : A Itti A NO"Pl.Aa,.114.14 ofslry Public Mgt urrr E J"iv ta.bola I tckavuw1odtpti that I ens the spouse of'the same fisted ladivtdual- 1 understand that my i compliance with lite esorttlitions set toot above. I3'it ht detenr�tined at.the&ope individual hes violated sr5 S(13 to Commission mr}y;_wutacoi.9,3 revoke the tt+gcter license. { 3i SignaEunc 4itiaividuwf lovolvedri„*oath applloatt'ron f rimed c p cr'gia individual (Spouse or llgc#Jvid+.+tt-i baited above) name of applying individual State Of..._-.CJ2,/,0.,:k ? _ • t t►tmiy of { t That!browsing instrument was acknowledged t,e1+nc me ti -r='d ="�st+n ;.. -4"- Am�s,.. NOTARY PUBLIC iC Mary Public r.lt3taatura __.___. STATE OF CC iCIFiA€lt7 hi TPPY ID 201`34000985 in ct».ias smile want the Auk.,isfis Vewxwl iftdavil.of aKi po i.n e,wvitajt•In cam R.i Y r S A sty -- A ion ilJy.MIvwNia p*Iad IN requpeod I, writing Kt /oeuuci ,ly. __....., ..,._.�._ t! �+IL peak..uW RitblEi7y(}..}yyi.(. t±0 tM 44. sweat L RECEIVED . JUN 9 2014 NEBRASKA LIQUOR (I i.n...7 et Ci Eric McDonald CONTROL COMMISSION District Supervisor Direct: 515-274-7533 6400 Westown Parkway I West Des Moines, Iowa 50266-9857 kumandgo.comII I:3 `" Please consider the environment before printing this e-mail. CONFIDENTIALITY NOTICE:This email message,including any attachments,is for the sole use of the intended recipient(s)and may contain confidential and privilege unauthorized review,use,disclosure or distribution is prohibited.If you are not the intended recipient,please contact the sender by reply email and destroy all copies of message.Please note that while we scan all e-mails for viruses,we cannot guarantee that any e-mail is virus-free. 2 0M1HA, N � City ofOmaha, fI'lebraskg 1819 Farnam—Suite LC 1 z ��` ,' `t """' Omaha, Nebraska 68183-0112 0� � ' co Buster Brown (402) 444-5550 ' ti' City Clerk FAX (402) 444-5263 o4 � NFU FEB1° July 1, 2014 Kum& Go, LC Application to appoint Eric P. McDonald manager Dba"Kum & Go #369" of your present Package Liquor License location 11111 Emmet Street 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 July 15, 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 pM�HA N City of Omaha Nebraska °� 8� 1819 Farnam—Suite LC 1 2 i'' t a Omaha, Nebraska 68183-0112 0' '..n.. �' J Buster Brown (402) 444-5550 A 1 City Clerk FAX (402) 444-5263 O ��E p FEBR��A July 1, 2014 Eric, P. McDonald Applications to be appointed manager of the 9370 Western Avenue present Package Liquor License locations Omaha, NE 68114 for Kum & Go, LC (See attached List) 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 July 15, 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, 464( C‘dAllgo Buster Brown City Clerk BJB:clj KUM & GO LC 4443 SOUTH 84TH STREET 68127 DBA KUM & GO #366 KUM & GO LC 4041 NORTH 168TH STREET 68116 DBA KUM & GO #368 KUM & GO LC 11111 EMMET STREET 68164 DBA KUM & GO #369 KUM & GO LC 13149 FORT STREET 68164 DBA KUM & GO #371 KUM & GO LC 7152 PACIFIC STREET 68106 DBA KUM & GO #372 KUM & qo __D City Of Omaha 1819 Farnam —Suite LC 1 Omaha NE 68183-00012 Dear City Council Omaha NE, This letter is to request a change of date for the Hearing on our application to appoint Eric McDonald manager for our Kum & Go#368 License 81772 located at 4041 N 168th St Omaha, NE 68116. Kum & Go#369 License# 83819 located at 11111 Emmet Street Omaha NE 68164 Kum & Go#371 License#78081 13149.Fort Street Omaha NE 68164 Kum & Go#372 License#47280 7152 Pacific Omaha NE 68106 Kum & Go#386 License*97931 4443 S 84th Omaha NE 68127 Due to a conflict in schedules we are requesting a move of the hearing date to July 22, 2014. Please contact me if you need any additional information Sincerely r i Lori Miller Licensing Specialist Phone(515) 457-6164 Fax (515)457-0159 lawn@kumandgo.com 6400 Westown Parkway,West Des Moines, Iowa 50266-9857 1515-226-0128 1 FAX 515-226-0995 www.kumandgo.com OMAH.l, � CityofOmaha, WeBras&a o �'��s 411111 Al I P- arerr t/1U1819 Farnam—Suite LC 1 2 4 Omaha, Nebraska 68183-0112 0®,� � �� ' Buster Brown (402) 444-5550 �A ti" City Clerk FAX (402) 444-5263 o,�'T �1,* Fp FEBR July 8, 2014 Kum& Go, LC Application to appoint Eric P. McDonald manager Dba"Kum & Go #369" of your present Package Liquor License location 11111 Emmet Street 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 July 22, 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, uster Brown City Clerk BJB:clj City of Omaha, WebraskgAo atfittirt1819 Farnam—Suite LC 1 2 a ^�®. r �► 7 Omaha, Nebraska 68183-0112 0�� "� ;f. Buster Brown (402) 444-5550 City Clerk FAX (402) 444-5263 o4# 2, ,\ S Fp FEBR July 8, 2014 Eric P. McDonald Applications to be appointed manager of the 9370 Western Avenue present Package Liquor License locations Omaha,NE 68114 for Kum& Go, LC (See attached List) 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 July 22, 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, ,e5LidiM141 Buster Brown City Clerk BJB:clj KUM & GO LC 4443 SOUTH 84TH STREET 68127 DBA KUM & GO #366 KUM & GO LC 4041 NORTH 168TH STREET 68116 DBA KUM & GO #368 KUM & GO LC 11111 EMMET STREET 68164 DBA KUM & GO #369 KUM & GO LC 13149 FORT STREET 68164 DBA KUM & GO #371 KUM & GO LC 7152 PACIFIC STREET 68106 DBA KUM & GO #372 No. Kum & Go, LC, dba "Kum & Go #369", 11111 Emmet Street, requests permission to appoint Eric P. McDonald manager of their present Package Liquor License location. 07-22-14;cj ty' RECEIVED Presented to Coun il: July 22, 2014 - pprnued 7- Buster Brown City Clerk i