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RES 2014-0836 - Appoint Taylor R Rucker manager of Staybridge Suites Omaha o' ate• F i' r 1 �a� STATE OF NEBRASKA �'�'' ��� .�► A Dave Heineman I 14 ,; ' 0 NEBRASKA LIQUOR CONTROL COMMISSION ''pa° ` ° Governor Hobert B.Rupe w?Rcy Deb 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 June 5, 2014 TRS USER 800 833-7352(TTY) web address:http://www.lcc.ne.gov/ OMAHA CITY CLERK 1819 FARNAM STREET LC-1 OMAHA NE 68183 RE: Manager Application Taylor Tucker LICENSE #C-106350 Dear Clerk: Enclosed is a copy of a manager application for Taylor Tucker in connection with the Staybridge Suites Omaha, 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 +aeu i/L<rA a aV1 1 Cif1100 USC RECEIVED INSERT-FORM 3c NEBRASKA LIQUOR CONTROL COMMISSION APR 29 2014 301 CENTENNIAL MALL SOUTH PO BOX 95046 NEBRASKA LIQUOR LINCOLN,NE 68509-5046 PHONE:(402)471-2571 CONTROL C O M M I S S I O(` FAX:(402)471-2814 Website:www.kc.nc_gov MUST BE: ✓ Citizen of the United States. Include cony of US irth certificate,naturalization naoer 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 NSF mail check only. ✓ 21 years of age or older � 1 „►RNl ��,���'T,^;=i_ �t -� 'r � #:#-+ } ,.. 1::...'"+�..73�..i� ....y?*..�.x�t)7rd�,k�.3�. "Lr#..�i.ak.� . Name of Corporation/LLC:_ I I 6 Q v 1A Wes, 3 B$,• -- Hp 1�` µ . .,,-8��.•5,•_.�1._.�,•' ... .--.'.,_:„ .R.:. .i(,. t_ T t. ,.i _.�...yt't«.i a�"..__. _. .. '.t.-. ..t; _.-.._._. a.. / J/ Liquor License Number: _ ' /Q 3 C) Class Type (if new application leave blank) Premise Trade Name/DBA:504.9r'1 SUke Premise Street Address: 11 DM '.e City: ()may), County: DO Vit15 Zip Code: (Pin4 Premise Phone Number: 140. 135 01 Email address:xa\pie , K PX Vid hC CDT° 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. httu://www.kc.nelovilicense searcli/licsearch.cel AT QUIRED flY CORPORATE OFHCER I MANAGING MEMBER (Faxed signatures are acceptable) RJUNECEIVFp5 Perm 103 Rev 9(1013 Page 2 orb 2014 NEBRASKA LIQUOR CONTROL COMMISSION 1400013085 . i n,. E �4✓. %.� i sX" PSS1"si I. .. ,a ° �� � a'�� r�� .� �� iv ,' i Last Name:-r6c.k.er First Name:`ZA OY MI: g• Home Address(include PO Box if applicable): I'100 6 'PIg2a A P1 201 City: Omaha County: pot `Q6 Zip Code: (.0q I t S Home Phone Number: 3Cii-t011 -3554 Business Phone Number: 462-1 3 3 -qq 0 I Social Security Number Drivers License Number& State: _ NE Date Of Birth: _ _ , Place Of Birth: Keay le\f 1 N ebrasv.c% Email address: TOty for. -tb&e)( VA c .Cori) ❑YES [ rNO 4 A Spouses Last Name: Fir st N ame: MI• Social Security Number: Drivers License Number&State: • Date Of Birth: Place Of Birth: as 1 ' 9 +. 1 „ CITY& STATE YEAR YEAR CITY& STATE YEAR YEAR FROM TO FROM TO RECE" J o JUN 5 24 N�gRASKp► QUO ON RECEIVED CONTROLc°---- ASS APR 29 2014 NEBRASKA LIQUOR Form 103 Form CONTROL COMMISSIOjage3of6 YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE FROM TO NUMBER 20t0 'ao12 Staboin�e sgotes Laic Markin 1A dt yo2 Lt31 1$2' pair+l e,id l n rl 2006 2010 Brian 3ohnSon L102 4-ap I0000 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 y 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 • RECEIVED JUN .5 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 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? [ YES ONO RECEIVED APR 2 9 2014 Forth 103 Rev 9/2013 NEBRASKA LIQUOR Page4of6 CONTROL COMMISSIOP 4. List the alcohol related training and/or experience(when and where)of the person malting application. Jj e P /to, '/I *NLCC Training Certificate Issued: Name on Certificate: Applicant Name Date Name of program(attach copy of course completion certificate) ( yyyy) RECEIVED JUN 5 20 i4 NER gsKA *For list of NLCC Certified Training Programs see www.lcc.ne.aov/traiI>!flONO A LIQUOR www.lcc.ne.aov/trainCONO ff�� L COmmiSSIQN Experience: Applicant Name/Job Title Date of Name&Location of Business: Employment: RECEIVED APR 2 9 2014 NEBRASKA 1 IQ.IJOR CONTROL COMMISSIOp 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) OYES ONO Form 103 Rev 9/2013 Page 5 of 6 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, orD fraudulent. RECEIVEJUN 5 2014 NEBRASKA LIQUOR Signature of Manager Applicant Signature of SpoICDNTROL COMMISSION ACKNOWLEDGEMENT State of Nebraka County of },juL `(kJ The foregoing instrument was acknowledged before me this � l L01I by TG.t.{IUr 1 date J name of person acknowledged Q. \ - V1a1 U Affix Seal Notary Public signature XENEWLMOTPRIsiblecOktals 1/Cala ft.Awn 14 MI ilIMOKNOTAN•fla Minis Mt hlrwtl lSNt�, 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 APR 2 9 2014 Form 103 Rev NEBRASKA LIQUO 91e 6of6f6 CONTROL COMMISSIOI' OMthHA, Nk•6� OF City ofOmaha, fI'lebras&a `� 1 /cp Ill1819 Farnam—Suite LC 1 � rIirto,4rt Er.t `a Omaha, Nebraska 68183-0112 0�24 � , Buster Brown (402) 444-5550 A City Clerk FAX (402) 444-5263 O4, FEBRIs+ June 17, 2014 LD1 NE Omaha, SBS, LLC Application to appoint Tayler R. Tucker Dba"Staybridge Suites Omaha" manager of your present Class "C"Liquor 7525 Davenport 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 July 1, 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, ,e‘eti Buster Brown City Clerk BJB:clj City of Omaha, Webras&a ili 1819 Farnam—Suite LC 1 ��iin if,E� .J -+t4"�""" N Omaha, Nebraska 68183-0112 02 4- � ", : ro Buster Brown (402) 444-5550 .o ti" City Clerk FAX (402) 444-5263 O, TFD FEBR 'r44 June 17, 2014 Taylor R. Tucker Application to be appointed manager of the 17008 Hawthorne Plaza, Apt#207 present Class "C" Liquor License location Omaha,NE 68118 of LD1 NE Omaha SBS, LLC, dba "Staybridge Suites Omaha", 7825 Davenport 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 July 1, 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, d4Z d° ‘°s Buster Brown City Clerk BJB:clj a ��i/' No. LD1 NE Omaha SBS, LLC, dba "Staybridge Suites Omaha", 7825 Davenport Street, requests permission to appoint Taylor R. Tucker manager of their present Class "C" Liquor License location. 07-01-14;cj RECEIVED Presented to Council: July 1, 2014 - Approved f—© Buster Brown City Clerk