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RES 2013-0604 - Appoint Leon Clarin manager of Granite City Food & Brewery tiIS`S Tq 4 e H Ft, t LJ STATE OF NEBRASKA ':Cr Dave Heineman NEBRASKA LIQUOR CONTROL COMMISSION 4 Governor 13 tIPP, 1 f 03: Hobert B.Rupe ba Executive Director 301 Centennial Mall South,5th Floor }' ;k P.O.Box 95046 Lincoln,Nebraska 68509-5046 Phone(402)471-2571 April 16, 2013 Fax(402)471-2814 or(402)471-2374 IRS USER 800 833-7352(TTY) web address:http://www.lcc.ne.gov/ OMAHA CITY CLERK 1819 FARNAM STREET LC-1 OMAHA NE 68183 RE: Granite City Food & Brewery LICENSE #E-074414 Dear Clerk: Enclosed is a copy of a manager application for Leon Clarin in connection with Granite City Food & Brewery located in Omaha. Please present this application for manager to your CityNillage Council or County Commissioners and send us the results of their action. Sincerely, ncXoc yz 7. Jacqueline Rodriguez Licensing Division NEBRASKA LIQUOR CONTROL COMMISSION 402-471-2572 end. Janice M.Wiebusch Robert Batt William F.Austin Commissioner Chairman Commissioner An Equal Opportunity/Affrrmative Action Employer Printed with soy ink on recycled paper MANAGER APPLICATION Office vso INSERT-FORM 3c RACE NEBRASKA LIQUOR CONTROL COMMISSION' 301 CENTENNIAL MALL SOUTH APR 2113 PO BOX 95046 �.r•1.►4008 LINCOLN,NE 68509-5046 NEbMJ V PHONE:(402)471-25.71 ^ oLCOM�� On FAX:(402)471-2814 ,QN Website:www.lcc.ne.gov 4 I' Corporate manager, including their spouse,are required to adhere to the following requirements 1) Must be a citizen of the United States 2) Must be a Nebraska resident(Chapter 2—006)and must provide proof of voter registration in the State of Nebraska 3) Must provide a copy of one of the following:state issued US birth certificate,naturalization paper or US passport 4) Must submit fingerprints(unless a non-participating spouse)(2 cards per person)and fees of$38 per person,made payable to Nebraska State Patrol 5) Must be 21 years of age or older 6) May be required to take a training course Name of Corporation/LLC: . (/ca4k{ C. +y —D S c. Premise License Number: —p 7 .! arArkr 2. Premise Trade aP (} Name/DBA: WY�- newfti�Tp'�. tL lea 4.,ti e blanCl a- vu 1 Premise Street Addr ess: ADD( /If. iOZA it Sirect City: (f lei et State: ,c Zip Code: &iIg Premise Phone Number: tfDZ ..1q 4 SDOD • 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. htto://www.lcc.ne.gov ' search/licsearchi Xe'l • ORPORATE OFFICER/MANAGING MEMBER SIGNATURE . (Faxed signatures are acceptable) Form 103 Rev 11/20I2 1300008187 ,sift) , � ) ' 1 +;'�" sa Li .: ° i rr.P J r s E ry e Gender. : •MALE ()FEMALE Last Name: K First Name: v#4! MI: tl• Home Address(include PO Box if applicable): L(Z4 5 19(s1 S7-9-a T City: OYikDk County: (a s Zip Code: (Le igS"- Home Phone Number: al t , ( ?,gq.3 Business Phone Number: yov 3?3 Saoo Social Security Number: Drivers License.Number& State: Date Of Birth: Place Of Birth: f L.SThb W14 : -r ..o z:t .eft • e � N rs . OYES 9NO Spouses Last Name: First Name: MI: Social Security Number: Drivers License Number&State: Date Of Birth: Place Of Birth: CITY&STATE YEAR ' YEAR CITY&STATE YEAR ' YEAR FROM TO FROM TO A/t zo)o G Z a99 Zoto SA S G115(r �-�+'� .ZOOS ZOO J RECEIVED Form 103 APR Rev 11/2012 APR 2 2013 Pogo 301'5 NEt Mv,v►i sutuoFt CONTROL COMMISS,O T .. I 1M YEAR NAME OF EMPLOYER ' NAME OF SUPERVISOR TELEPHONE FROM99 TO /^ �^'-, C NUMBER Zvi i/ l� 6ra1Ar''� f�A 1f rc4"�' l f+, L 1 J� r`' Z .. ZOlt CL..1/4.4 c.�e R*Jeri. S1C.Vt COr'(c(d.( l_ 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. 9YES NO If yes,please explain be ow or attach a separate page. Name of Applicant Date of Where Description of Charge Disposition Conviction Convicted (nun/my) (city&state) RECEIVED 2Y n �jpp �� rG NEt innuiv,"ueuOFt CONTROLCOMMISSIOtN 2. Have you or your spouse ever been approved r made application for a liquor license in Nebraska or any other state? (YES WO IF YES,list the name of the premise. 3. Do you, as a manager,qualify under Nebraska,Liquor.Control Act(§53-13l 01)and do you intend to @Y supervise, in person,'the management of the business? ES (10 4.' Have you enclosed ed the required fingerprint cards and PROPER FEES with this application? heck or mone order made payable to the Nebraska State Patrol for$38.00 per person) S10 5. List any alcohol related training and/or experience(when and where). .644/S#1,15- "Aeor/A9t- z7/Zz/Zoi; 4ramik ecel‘i 6foomit 7,-;,:wr- f4 ,^esim-r4-ir Form 103 Rev 11/2012 Page 4 of s p 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. anger Applic nt Signature of Spouse ACKNOWLEDGEMENT State of Nebraska County of -"DC g\as The foregoing instrument was acknowledged before me this ' th . �t� oC N1xr 2DI5 by L eorl r Cl o,r i n 3rd date of person acknowledged tY)nite,u A. Wcaiuxulg. Aix sal Notary Public signature GENERA.NOUN-SW d U ndo MARCIE A.WOODWAFID *CommEm0. lt11a 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 ' 2013 Form 103 Rev 11/2012 NEbnnar<v,,..i.tuOR Page 5of5 CONTROL COMMISSIOR' City o 0 "afil 4 • Co)0/40-41:4111 12. 1819 Farnam —Suite LC 1 1 Omaha, Nebraska 68183-0112 ®® Buster Brown (402) 444-5550 City Clerk FAX (402) 444-5263 ® �D FEB � April 24, 2013 Granite City Restaurant Operations, Inc. Application to appoint Leon H. Clarin manager Dba"Granite City Food &Brewery" of your present Class "C" and Class "L" Brew 1001 North 102' Street Pub Liquor 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 May 7, 2013 . 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 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 ^ 9 �� OmaIia tsi•' 6 f � sew � , n , 1819 Farnam— Suite LC 1 z �� 7,�j : Omaha, Nebraska 681 83-01 1 2 ®v ; :; Buster Brown (402) 444-5550 ® ` City Clerk FAX (402) 444-5263 ` �- `jt" -,' April 24, 2013 Leon H. Clarin Application to be appointed manager of the 6121 South 191St Street present Class "C" and Class "L" Brew Pub Omaha,NE 68135 Liquor License location for Granite City Restaurant Operations, Inc., dba"Granite City Food & Brewery", 1001 No. 102nd St. 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 May 7, 2013 . 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 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 No. 60 Granite City Restaurant Operations, Inc., dba "Granite City Food & Brewery", 1001 North 102nd Street, requests permission to appoint Leon H. Clarin manager of their present Class "L" Brew Pub License location. 05-07-13;cj tl RECEIVED Presented to Council: May 7, 2013 - Approved 7 G Buster Brown City Clerk