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RES 2014-0781 - Appoint Phyllis M Reiser manager of AVP Energy #3 O4'SNg ST,t (14 f STATE OF NEBRASKA its, �^ " a Dave Heineman '�_ NEBRASKA LIQUOR CONTROL COMMISSION �"'"°_a Governor - Hobert B.Rupe 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 May 28, 2014 TRS USER 800 833-7352(i'i Y) web address:http://www.Icc.ne.gov/ OMAHA CITY CLERK 1819 FARNAM STREET LC-1 OMAHA NE 68183 RE: Manager Application Phyllis Reiser LICENSE #D-88430 Dear Clerk: Enclosed is a copy of a manager application for Phyllis Reiser in connection with AVP Energy#3, 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, • 0,44.4./.Lza.? 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 r — MANAGER APPLICATION Office Use INSERT-FORM 3c RECEIVED NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH SAY 5 2014 PO BOX 95046 LINCOLN,NE 68509-5046 PHONE:(402)471-2571 NIEBRA$KA LIQUOR FAX:(402)471-2814 CONTROL COMMl's�,iioN Website:www.lcc.ne.gov MUST BE: ✓ Citizen of the United States. Include copy of US birth certificate,naturalization paper or Q-- current US passport ✓ Nebraska resident. Include copy of voter reeistration 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. 1 21 years of age or older Name of Corporation/LLC: A V r Eriernit L L� Liquor License Number: 0 8 143 0 Class Type D (if new application leave blank) Premise Trade Name/DBA: S%Y O.i au-r C A V P -3' Premise Street Address: I© 5 Q 5 P&.c,.I- City: 11466q. r 0. County p u St QS Zip Code: i t r`i Premise Phone Number: 4 Q 2. 3q 3 - 9 54 Email address: 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:// c.ne.¢ov/license search/licsearch.cgi 11 kievk � TR�9"j5' �' F S SI:GNOVO:� 1104 r` o O ,TE OftF 'C1 1 i 0 (Faxed signatures are acceptable) Form 103 Rev 9/2013 Page 2of6 i 1400011076 Last Name rR,et S Qr First Name 1rt 1 1 S MI: m Home Address(include PO Box if applicable): f M 54 C or 104 5i-reQ-+ City: Om&lot 0., County Icy Zip Code:43164. Home Phone Number:4(32-'a(p"393s Business Phone Number: Social Security Number: - Drivers License Number& State: /V fE Date Of Birth:_ - — Place Of Birth: dyticIle.a. E Email address: RECEIVED YES O NEBRASKA LIQUOR Spouses Last Name: First Name: MI: Social Security Number: Drivers License Number&State: Date Of Birth: Place Of Birth: YEAR YEAR • CITY&STATE CITY&STATE YEAR YEAR FROM TO FROM TO I x4S1 or1 Osta14 ' — Form 103 Rev 9/2013 Page 3 of 6 YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE FROM TO NUMBER 2oi fi e-t-AvP Energy �eno�r�y, ** -3o7-2325 /171 1 q97 VA Hessp Z'acun Ct.a.;~-z. on-45(-5746 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 : I .•- ear and month of the conviction or plea. Also list any charges pending at the time of this application. If .. t EiDlease list charges by each individual's name. ❑ YES JZI NO MAY 5 2014 If yes,please explain below or attach a separate page. NEBRASKA LIQUOR Date of Where DescQONTROL COMMISSION on 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 g) 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? OYES ONO 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: Name on Certificate: Applicant Name (mm/yyyy) Name of program(attach c fiE� n certificate) MAY 2014 NEBRASKA LIQUOR CONTROL OOMMIi®ION '"For list of NLCC Certified Training Programs see www.lcc.ne.gov/traininginfo.html Experience: Applicant Name/Job Title Date of Name&Location of Business: Employment: 1141.0 t5 'Rel5er /1e5C4r5e IgT7+,ncti VA kteNaraskra-t6 en loza jiai n Care-Sto 4-21,4 4t of t c klr, A44L J 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$38.00 per person) , YES ENO Form Rev 9/2010313 Page 5 of 6 r The above individual(s), being first duly sworn upon oath, deposes and states that the undersigned is the applicant and/or spouse of applicant who makes the above and foregoing application that said application has been read and that the contents thereof and all statements contained therein are true. If any false statement is made in any part of this application, the applicant(s) shall be deemed guilty of perjury and subject to penalties provided by law. (Sec §53-131.01)Nebraska Liquor Control Act. The undersigned applicant hereby consents to an investigation of his/her background including all records of every kind and description including police records, tax records (State and Federal), and bank or lending institution records, and said applicant and spouse waive any rights or causes of action that said applicant or spouse may have against the Nebraska Liquor Control Commission and any other individual disclosing or. releasing said information to the Nebraska Liquor Control Commission. If spouse has NO interest directly or indirectly,a spousal affidavit of non participation may be attached. The undersigned understand and acknowledge that any license issued, based on the information submitted in this application, is subject to cancellation if the information contained herein is incomplete, inaccurate, or fraudule t. -4() . * ignature of Ma ger Applicant /40 Signature of Spouse ACKNOWLEDGEMENT State of Nebraska County of Dac46 Lek The foregoing instrument was acknowledged before me this Zrrmo.,.9 At A/ca` 2OrN by P. YctNS t-L %bre c date name of person acknowledged `1 71" !"'1% Affix s BENJAMIN DAM TIFFANY '���' otaryPublic signature Gomel Notary 1 +NW' gn ' Stole of N My Commis$LDA Ex/ks$Jun S,2016 ( 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 9/2013 Page 6 of 6 RECEIVED MAY 5 2014 NEBRASKA LIQUOR CONTROL COMMISSION 0MAHA. 1Vcrb City o Oma a, Ne bras a ��\ 1 9s� 1819 Farnam—Suite LC 1 2 4,111tJ - a"�" Omaha, Nebraska 68183-0112 0��- -3 "�_ r �' Buster Brown (402) 444-5550 0 City Clerk FAX (402) 444-5263 dt�rFo FEBR��� June 10, 2014 AVP Energy, LLC Application to appoint Phyllis M. Reiser Dba"AVP Energy#3" manager of your present Package Liquor 10505 Pacific Street License location Omaha,NE 68114 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 24, 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, r‘ereoddmagi Buster Brown City Clerk BJB:clj IO A.•HA, City ofOmafia, Webraskg /t. � �6 liT .. T Z"tt 1819 Farnam—Suit 2 . .� ^ ®' Omaha, Nebraska 68183-0112 o Buster Brown (402) 444-5550 A City Clerk FAX (402) 444-5263 °',047'to FEBRA June 10, 2014 Phyllis M. Reiser Application to be appointed manager of the 12954 Corby Street present Package Liquor License location Omaha,NE 68164 for AVP Energy, LLC, dba"AVP Energy #3", 10505 Pacific 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 June 24, 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 5- No. 77/ AVP Energy, LLC, dba "AVP Energy #3", 10505 Pacific Street, requests permission to appoint Phyllis M. Reiser manager of their present Package Liquor License location. 06-24-14;cj RECEIVED Presented to Council: June 24, 2014 - aico ea Gvc'r' It 1 5 2014 'pie' v Buster Brown City Clerk Buster Brown (CClk) <buster.brown@ci,omaha.ne,us> City Council Meeting Reschedule Request 1 message Seth Hendrix <shendrix@avpenergy.com> Wed, Jun 18, 2014 at 9:32 AM To: buster.brown@ci.omaha.ne.us It is possible to reschedule the meeting for AVP Energy #3 liquor license manager hearing scheduled 6/24/14 to 7/15/14? Seth Hendrix General Manager AVP Energy 7229 S. 85th East Avenue # 400 Tulsa, OK 74133 Office: 918-307-2225 Fax: 918-307-2226 No. 7k/f Communication from Seth Hendrix, General Manager of AVP Energy, LLC, dba "AVP Energy #3", 10505 Pacific Street, requesting to lay over the application to appoint Phyllis Reiser manager to July 15, 2014. 06-24-14;cj a/I/ RECEIVED Presented to Council: June 24, 2014 -From chair OAge Buster Brown City Clerk }