RES 2014-0779 - Appoint Christopher S Dalton manager of Roja Mexican Grill & Margarita Bar •
os.E ST,1 J
F .A' 4 r
STATE OF NEBRASKA
< Dave Heineman
_ f-, NEBRASKA LIQUOR CONTROL COMMISSION
r... A; Governor Hobert B.Rupe
Ir14t 1 ib°4__ Executive Director
301 Centennial Mall South,5th Floor
P.O.Box 95046
i:.
Lincoln,Nebraska 68509-5046
Phone(402)471-2571
Fax(402)471-2814 or(402)471-2374
May 30, 2014 TRS USER 800 833-7352 CITY)
web address:http://www.lcc.ne.gov/
OMAHA CITY CLERK
1819 FARNAM STREET LC-1
OMAHA NE 68183
RE: Manager Application Christopher Dalton
LICENSE#I-88387
Dear Clerk:
Enclosed is a copy of a manager application for Christopher Dalton in connection with the Roja
Mexican Grill & Margarita Bar, 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 oMee use
INSERT-FORM 3c RECEIVED
NEBRASKA LIQUOR CONTROL COMMISSION MAY 16 2014
301 CENTENNIAL MALL SOUTH
PO BOX 95046
LINCOLN,NE 68509-5046 NEBRASKA LIQUOR
('HONE:(402)471-257I
FAX:(402)471-2814 CONTROL COMMISSION
Website:www.icc.ne.aov
MUST BE:
I 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 S38 per person,made payable to Nebraska State
Patrol. If printed at NSP mail check only.
1 21 years of age or older
COl f&tionf tfO ton ` ; s: w a ' a. , ` d'F t„3s z i 4� 'r
• I X0'a //
Name of Corporation/LLC: �,t,�---::_-.,e��■ae►.�.:•Zs,���,,;��� _ � � � � Li
Premise:information..$° 6 b x ,, , :,, ,t; z, :J, . � .; ;,� . ' ;W' - l° ell?
• Liquor License Number: O 883e)R Class Type
(knew application leave blank)
Premise Trade Name/DBA: i4 31111., y c GCi l.i '+ tY)3TAck- tor
Premise Street Address: I41 Z td4. S"-
City: Otyurc , County: il-)ci g Zip Code: ( OZ
Premise Phone Number: tt-I OZ.) (0' "q i Cd
Email address: b t- n @ fooa,,T I, . [,c/M
The individual whose name is listed as a corporate officer or managing member as reported on insert
form 3a or 3b or listed with the Commission. Click on this link to see authorized individuals.7httn://www.kc.ne.no nse rcb/licsearch.*
SIGNATURE REQ D BY CORPORATE OFFICER/MANAGING MEMBER
(Faxed signatures are acceptable)
14ann 103
Rev 9/2013
11111111111 Page 2orb
1400011089
Last Name: First Name: ()Nt.1*-) rar MI: S
Home Address (include PO Box if applicable): VoOZ,, N 11046 c*. f 20
City: 1C k.\'` . County: Zip Code: (981 V L(
Home Phone Number ( )Sley''533 Business Phone Number:00z 5 1 c3:
Social Security Number: _ _Drivers License Number& State.
Date Of Birth: _ _ Place Of Birth: 0 Y)Q,V
Email address: *.&C1tA K1 , C CP-%
YES ANO
• . ' "�..� : t A' ,.� i��- .. @n
Spouses Last Name: First Name: MI:
Social Security Number: Drivers License Number& State:
Date Of Birth: Place Of Birth:
CITY& STATE YEAR YEAR CITY& STATES YEAR
FROM TO FROM TO
6NrrANK I 1\11, IS$r' Zo Itt
Form 103
RECEIVED Rev 9/2013
Page 3of6
MAY 1 6 2014
NEBRASKA LIQUOR
CONTROL C MA otgo'
..v
YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE
FROM TO NUMBER
ZD14 Z014 (Zc\P. k ,cx k- 1,402S 59ti-A°5
Zoo( 2 014 bc,1/414 c1,4.S 3-ohm Cii0¢.1 S91- A
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
alfts i*COutr DAAttA ‘ki Oft)t0. Aine
2. Have you or your spouse ever been approved or made application for a liquor license in Nebraska or
any other state?
OYESi0
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?
'AYES ONO RECEIVED
rm 103
MAY 16 2014 Re°9/2013
Page 4 of 6
NEBRASKA LIQUOR
CONTROL COMMlSSit' N
4. List the alcohol related training and/or experience(when and where)of the person making application.
'riLCC Training Certificate Issued: Name on Certificate:
Applicant Name Date Name of pragtam(cinch copy of course(mtnIX)7 ) completion certificate)
1C 2t,t 3 Sack, Y44- k
*For list of NLCC Certified Training Programs see
Experience:
Applicant Name I Job Title Date of Name do Location of Bossiness:
�y
Employment:
)`; .gin`�'7 a Jb\V (�t x'rti t'�C141 ViN01.WX.IN
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 S38.00 per person)
AYES ONO
Falb 103
P.v 9/2013
RECEIVED `ma`s°"
MAY 16 2014
NEBRASKA LIQUOR
CONTROL COMMISSION
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
Signature of Manager Applicant Signature of Spouse
ACKNOWLEDGEMENT
State of Nebraska
County of Bay-4--rQ,c,Q/ The foregoing instrument was acknowledged before me this
• /4 g o2O/IG &by C d/ /(1/ dci
r
date name of person acknowledged
W Affix See.4:61/01.NOTARY-State of
Nebraska
N ry Public signature NANCY S.WYNKOOP
My Comm.Exp.Sept.26,2015
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
013
RECEIVED Pav 6 of
Page 6 of 6
MAY 16 7014
NEBRASKA LIQUOR
CONTROL COMMISInN
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HAS SUCESSFULLY COMPLETED
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Date of Training I 0/8/20113
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Test Score 80%
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Sergeant Martin Costello, Nebraska State Patrol
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' Instructor Valid Ibr Three Years from Date of Training
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NEBRASKA LIQUOR
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OMAHA.-1V4,
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CityofOmaha, Ne bras a .� 11usa„,,,....5,1*
aill
1819 Farnam— Suite LC 1 ��k�.JiiikVIZ
Omaha, Nebraska 68183-0112 0��-= - � ',_;y. �'
Buster Brown (402) 444-5550
City Clerk FAX (402) 444-5263 04.?iWto B FEs ••
June 10, 2014
Old Market Roja, LLC Application to appoint Christopher S. Dalton
Dba"Roja Mexican Girll & Margarita Bar" manager of your present Class"I" Liquor
1212 Harney Street License location
Omaha,NE 68102
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,
44(0e111014*
Buster Brown
City Clerk
BJB:clj
Cityo Omaha e6ras �
, a `u .��_�
� Ksral�!''�Ar
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1819 Farnam—Suite LC 1 �tr a
Omaha, Nebraska 68183-0112 0� � ", -
Buster Brown (402) 444-5550 .o 1,"
City Clerk FAX (402) 444-5263 04 �
TFD FEBRUt+
June 10, 2014
Christopher S. Dalton Application to be appointed manager of the
12602 N Ames Plaza, Apt#207 present Class "I" Liquor License location
Omaha,NE 68164 for Old Market Roja, LLC, dba"Roja
Mexican Grill & Margarita Bar", 1212
Harney 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,
4e5r1Weld
Buster Brown
City Clerk
BJB:clj
No. 779
Old Market Roja, LLC, dba "Roja Mexican
Grill & Margarita Bar", 1212 Harney Street,
requests permission to appoint Christopher S.
Dalton manager of their present Class "I"
Liquor License location.
06-24-14;cj
RECEIVED
Presented to Council:
June 24, 2014 - ra`tp .hQ
, TaTh � 7- I-I oral'
Conti ..P iris Clair r 7-C
- 1 2014-p rawer �-
Buster Brown
City Clerk