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RES 2013-0605 - Appoint Ian Rockwell manager of 801 Chophouse 04, STATE OF NEBRASKA ��!tz • >s' Heineman13 ' ? n'' ^. ! NEBRASKA LIQUOR CONTROL COMMISSION ,•'��,� .w ,� Dave : ;, � � t, • A' Governor Hobert B. Rape Executive Director �, v 301 Centennial Mall South,5th Floor P.O.Box 95046 ,> !„l Lincoln,Nebraska 68509-5046 Phone(402)471-2571 April 9, 2013 Fax(402)471-2814 or(402)471-2374 TRS USER 800 833-7352(ITY) web address:http://www.lcc.ne.gov/ OMAHA CITY CLERK 1819 FARNAM STREET LC-1 OMAHA NE 68183 RE: 801 Chop House LICENSE #I-073674 Dear Clerk: Enclosed is a copy of a manager application for Ian Rockwell in connection with the 801 Chop House 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, Jacqueline Rodriguez a 9 Licensing Division NEBRASKA LIQUOR CONTROL COMMISSION 402-471-2572 encl. Janice M.Wiebusch Robert Batt William F.Austin Commissioner Chairman Commissioner An Equal Opportunity/Affirmatiue Action Employer Printed with soy ink on recycled paper MANAGER APPLICATION Office Use INSERT -FORM 3c RECEIVED NEBRASKA LIQUOR CONTROL COMMISSION MAR " Z013 301 CENTENNIAL MALL SOUTH PO BOX 95046 NEBRA A 1: ,',UOR LINCOLN,NE 68509-5046 CONT Ps CI§.. ;23.1 rd i., ' N PHONE: (402)471-2571 FAX: (402)471-2814 Website:www.lcc.ne.gov 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 44C,E. 4) Must submit fingerprints (unless a non-participating spouse)(2 cards Aehies of$38 per person, made payable to Nebraska State Patrol 5) Must be 21 years of age or older AN: c 2013 6) May be required to take a training course Eb mDio-11..t i "" 4 rrq!1 i •• v, Name of Corporation/LLC: e6 1 i i,..,,S e / 11-k4.t ay] 114✓3-t %f 'r1se infoa** 144 i . '4 , 4� ' Premise License Number: .r D: .3 (e 9-4/ (if new application leave Tank) Premise Trade Name/DBA: o ! L qk,%,,. "' , V)( i4. Premise Street Address: /y i 3 Icr u pki t "f` City: t2,iis # k State: NE Zip Code: 67/6 Premise Phone Number: I/d 42- 3 y/, /2 2 2. 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/license search/licsearch.cgi 4-----;.. .. '_.,,---f...e =77 CORPORATE OFFICER/MANAGING MEMBER SIGNATURE (Faxed signatures are acceptable) Form 103 :v 11/2012 'age 2 of 5 1 III 1111111 1300006137 1 -9 r 1 € '@ x i $ I1 i77) 1 e�yy 0•l' d�A lur �'kq :m. Gender: MALE ©FEMALE Last Name: Rc. ktt t ( First Name: ,./-& r-t MI: At Home Address (include PO Box if applicable): /3o?3 ;7-a ck t 4... S'./}-•ct # '," City: (2,1,14,11`•- County: *be,..,.✓ la 5 Zip Code: L 0 r 0 Z Home Phone Number: 3i'. 24 r u tti 3 Business Phone Number: L1 v a, 31/ 1 . 11_22- Social Security Number:_ 42 Drivers License Number& State: —AiE Date Of Birth: _ Place Of Birth: C ik•�� , /4 ,If _ " Z013 44*YES ONO tt�r� a ti ['N,t4,c tv-t tuluuUOR Spouses Last Name: Re...t:A4i 1I cti First Name: L i` c l MI: A) • Social Security Number: _Drivers License Number&State: __ - "/f Date Of Birth: _ Place Of Birth: b�/,� vt) f'� CITY& STATE YEAR YEAR CITY& STATE YEAR YEAR FROM TO FROM TO b M4,14tt) AK L e2 i !J�/et7,C f ��li�ti,r N G 26f( Cv✓Y!.(T Form 103 Rev 11/2012 Page 3 of 5 I 1 IP YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE FROM TO NUMBER 0200$ prof.f cot. ( ay ith(Li 5k-vc 0,5"oeK Pr. 3/4A /5$ 200S- ?•OO5 , cc., .e.ey L-a .'+ 5+c\ (dKniet,ln;.A., 3 r''. 4100-/t/ f 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 applicat !i1f4 party,please list charges by each individual's name. YES NO Res,please explain below or attach a separate page. !i rit 3 2013 y Name of Applicant Date of Where ihiai'ge r Disposition Conviction Convicted `70hr ,rr>'t, (-.nAt1114 t;Q1(1P. (mm/yyyy) (city&state) ' ! .tom MAR 2,5 2113 NN— r�0Nw '9e r~" coly... t�� 11 2. Have you or your spouse ever been approved r made application for a liquor license in Nebraska or any other state? OYES 0 •e •a• a ofth- . e ise. -.4.10 i,.1I3t8844. visa*manse 3. L? o}yUIi'a ,,�u, alif u 1 er Nebraska Liquor Control A (§53-131 01)and do you intend to .- M - .-rson the'tri _: ent of the business? ES 010 4. Have you enclosed the required fingerprint cards and PROPER FEES with this application? Che 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). "Pas {r( M eI hl AL 1. m 45 .fin, S 4L��(,��...Gr� Y IZc r`�5�� C cs /� 0 U 4,4r7 Form 103 I Rev 1112012 Page 4 of 5 pERsolmmAto AND CENT Q INIVEgri 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. 1 Signature of Manager Applicant "ature o e ACKNOWLEDGEMENT State of Nebr ka County of 1U Iry The foregoing instrument was acknowledged before me this Y, 111 1 "1 1 _ by wru��J\�1�R11�11111A'�t111�11 I t) ,m gin 3 vbirA Ver116 1111 Alir Affix Seal Wir ot.''P olio signature I JESSICA L.itOEHLE Sound Notary Stab N Nebraska • My Gahm scion Expires Oct 23.2016 r 4 • 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 11/2012 Page 5 of 5 Print.Form SPOUSAL AFFIDAVIT OF Office Use NON PARTICIPATION INSERT NEBRASKA LIQUOR CONTROL COMMISSION RECEIVED 301 CENTENNIAL MALL SOUTH PO BOX 95046 LINCOLN,NE 68509-5046 MAR 2 0 2013 PHONE:(402)471-2571 1 FAX:(4 www.lcc.ne.gov 14 ne N ntworet UUUO R Website: www.lcc.ne.gov e,lThi°rorif rwiannaltz*iifin I acknowledge that I am the spouse of a liquor license holder. My signature below confirms that I will have not have any interest,directly or indirectly in the operation or profit of the business(§53-125(13))of the Liquor Control Act. I will not tend bar,make sales,serve patrons,stock shelves,write checks,sign invoices or represent myself as the owner or in any way participate in the day to day operations of this business in any capacity. I understand my fingerprint will not be required;however,I am obligated to sign and disclose any information on all applications needed to process this application. j� m F��T J • �(\ Ldaur `01vEI Sign e fs,ouse a or waiver Printed nam spouse asking or waiver ouse o ' •ividual listed below) a i'!ti : 2013 State of NieDro s lr� k�r}p f6 �yyyy' } „R County of U d 14 1 The foregoing instrument v tlbW1cfcct08M t '1'rititNis i 2 ( 3 by Atkew -S. it't A , date name of person acknowledged tiwt/ A y ANDREW.J HINTZ Not Public signature Stets of Nebraska My Niumlaslun Exphes Apr b,21)15 I acknowledge that I am the spouse of the above listed individual. I understand that my spouse and I are responsible for compliance with the conditions set out above. If it is determined that the above individual has violated(§53-125(13))the Commission may cancel or revoke the liquor license. 1 -bcICwi-LL Signature of individual involved with application Printed name of applying individual (Spouse�o�f individual� listed above) State of 1`1 1(��\CA County of \ O\(4(i The foregoing instrument was acknowledged before me this by V V4 7\ NAI� te name of person acknowledged Affix Seal y 1 signature 1 JESSICA t.BOENLE General Notary Stets of*tweaks In compliance with the ADA,this spousal affidavit of non participation is available in other formats 8br petkitAMMMIMOiiiiMfM1 Oct 23,2018 A ten day advance period is requested in writing to produce the alternate format. FORM 35-4178 Revised 1/2008 0�1fvE ' lvi, T: I�fI - c I ) '!jl,,F'//�/f77 J �,'/jJ �� .{sxJ`f'/'///jJ (.L+/tu'�l9t' 1:9�� S l tom. /�U' 1:`�L C=�c/ 5+(7 r° J\' k ` 1,r 'Io �1 1819 Farnam —Suite LC 1 z`, v� �`:411 - _ IA Omaha, Nebraska 68183-0112 ®* �' A,�1+r ,, cluster =srr•awn (402) 444-5550 F City Clerk FAX (402) 444-5263 '' - �� April 24, 2013 Paxton Chop House, LLC Application to appoint Ian M. Rockwell manager Dba"801 Chophouse" of your present Class "I" Liquor License location 1403 Farnam Street, Suite 102 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 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 0 Umana IV f� � 1, gY A �� ► .12. a . 1819 Farnam—Suite LC 1 ; �Witictk �, �, Omaha, Nebraska 68183-0112 0 Nts . Buster Town (402) 444-5550 City Clerk FAX (402) 444-5263 ®�� � � April 24, 2013 Ian M. Rockwell Application to be appointed manager of the 1323 Jackson Street#607 present Class "I" Liquor License location Omaha, NE 68102 for Paxton Chop House, LLC, dba"801 Chophouse", 1403 Farnam St., Ste 102 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, Tap'✓ Buster Brown City Clerk BJB:clj No. o Paxton Chop House, LLC, dba "801 Chophouse", 1403 Farnam Street, Suite 102, requests permission to appoint Ian M. Rockwell manager of their present Class "I" Liquor License location. 05-07-13;cj RECEIVED Presented to Council: May 7, 2013 - Approved --c Buster Brown City Clerk