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RES 2012-1525 - Appoint Anthony B Ulses manager of Granite City Food & Brewery• f 0.4 1• T9T\ a • 4 RECEIVED C� STATE OF NEBRASKA 2 OCT Zb a _ 1 i' , • NEBRASKA LIQUOR CONTROL COMMISSION i nI U Dave Heineman ` Governor Hobert B. Rupe Executive Director CITY CLERK 301 Centennial Mall South,5th Floor OMAHA. NEBR4S K/i P.O.Box95046 Lincoln,Nebraska 68509-5046 Phone(402)471-2571 October 22, 2012 Fax(402)471-2814 or(402)471-2374 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: Granite Cit Food & Brewery LICENSE C-074411 #L-074412 Dear Clerk: Enclosed is a copy of a manager application for Anthony Ulses in connection with Granite City Food & Brewery 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, a-CIA-T-627 Jacqueline Rodriguez Licensing Division NEBRASKA LIQUOR CONTROL COMMISSION 402-471-2572 encl. Janice M.Wiebusch Robert Batt William F.Austin Commissioner Chairman Commissioner An Equal Opportunity/Affirmative Action Employer Printed with soy ink on recycled paper e 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, .4594 ,:.. Buster Brown City Clerk BJB:clj Sign e of Manager Applicant Signature of S Char s V line Je l,: Kline rftcay e) ACKNOWLEDGEMENT F:.r_..00T 2 8 2012 State of Nebraska CONV;, LfC� County of Douglas The foregoing instrument was • .•/ •�,=n, ,•s.,i ®� this P\Ntt, 11 a— bY Charles V. Kline and Jean L. Kline name of person acknowledged al.Affoc Seal Notary Public signature JOHN C 1MELAND !if Coen.Eq.limbo,V.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. RECEIVED SEP 18 2017.. hraiiiiiSKA LIQUO ev11/g CONTROL COMMISS. l 5 of 5 SIGNATURE (Faxed signatures are acceptable) Form 103 1012 of 5 1200020192 is spousal affidavit of non panicipation is available in other formats for parsons with disabilities. A ten day advance period is requested in writing to produce the alternate format. FORM 35.4178 • Revised i f2008 his application is available in other formats for persons with disabilities. A ten day advance period is required in writing to produce the alternate format. ' i=ECEIVE !: :: Form 103 OCT 112012 Rev1t/2012 Page s or s hr. �� LitaIUOR CONTROL COMMISSION 000 2012 • , . . :ri• _ r,ECElv Eli .,.: Form 103 OCT 1 1 niz Rev 11/2012 Page 3 of 5 WEBRASCIV4 LIQUOR CONTROL COMMISSION , . - . retary Form 103 Rev 11/2012 Page 2 of S 1200020151 MANAGER APPLICATION oases use f"' CMIEn INSERT-FORM 3c NEBRASKA LIQUOR CONTROL COMMISSION OCR 4 201Z 301 CENTENNIAL MALL SOUTH �EBVIA5 Ui lL.1 1�®R PO BOX 95046 LINCOLN,NE 68509-5046 ��®�'�®�M� 1® PHONE:(402)471-2571 FAX:(402)471-2814 4g" Website:wwwicc.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 4) Must submit fingerprints(unless a non-participating spouse)(2 cards per person)and fees of$38 per person,made payable to Nebraska State Patrol 5) Must be 21 years of age or older 6) May be required to take a training course M t e Y ,„'�? aWGr.r .p ^,?4 i,L l e'i r" ` i'}'^r r� .5. •. ' ta 44 40 � , ti , I t t- TVil. i 4.#' � v .a: .e�i ,„,.,r F� Ati � m t - .iq w� ,4 gv9zog ` t"M,4 ,11ti wI , l , x4::!,,,',...., !,,,y� 'L& r ..,,t77,4 .+, 43 0.', K4 a� 'i 3" 5 ;,LAT, t2a. 03-eg Name of Corporation/LLC: &V2L Alt-6 lei I226 Lt/vv/ OpotIA-1-?\4Asj;i4c. � k 7 itl 0 as�Lx'i�7��r�''4 fA. '�* y *y�rvY irnvt i = 4 t... ,fro' e lx,64.,t .. .L. U _A e. r tp •" 1 7'wi e 1:-__ TI l .» s`Fd3,' S yy 9 S'"f 7 � t t tr ,,Wyy M1� Vy f s .*t. � +. I e u sP� �� 6.P'. � .L '$ .. 7•�Jt. �_y'':'t 1 ., � y+'^Mid � ,w s ,i' t`� , m P k. F 4 y �t° t3 4�^ 7 ' t k V , 't.— 5,.a y, bpi r,.. r r h 4, 9k . fit,. s,c 4 uu�,$ i .. q^ 9'—�.`�Sk 2 pad' �,. �: ..�.�C,..c �`v�i"tfi �c A',Jura ,� ,``„"�emrK6i tB"�.+w i�?r'3r','`F,a�i}��`a roan' y.• Premise License Number "`� of Thew appli en ve bl Premise Trade Name/DBA: ? r'01,Utt j( �- gle&"/"..ivy Premise Street Address: I 601 I, I 0 - City: OV1L(.L1fLC1\ State: I v E„ Zip Code: , Lj Premise Phone Number: 1-1'Oa- + J l - ¶ 1 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 i L, r,fission. Click on this link to see authorized individuals. httn://www.lcc.ne.g. ire ' csearch.cgi % r' 'ORATE OFFICER/MANAGING MEMBER SIGNATURE (Faxed signatures are acceptable) RECEIVED Rev Fel1/nn201 103 2 OCT 222012 r�eaoes (;ON1'R®1..C®MM 1200020184 • Revised i f2008 his application is available in other formats for persons with disabilities. A ten day advance period is required in writing to produce the alternate format. ' i=ECEIVE !: :: Form 103 OCT 112012 Rev1t/2012 Page s or s hr. �� LitaIUOR CONTROL COMMISSION 000 2012 • , . . :ri• _ r,ECElv Eli .,.: Form 103 OCT 1 1 niz Rev 11/2012 Page 3 of 5 WEBRASCIV4 LIQUOR CONTROL COMMISSION , . - . retary Form 103 Rev 11/2012 Page 2 of S 1200020151 � vw � r r r a h=rr,, , K -- .. - ..,ir.x,.. .'r"=' i;u-- rj..r-•,, �` ._., ' n 4r3: Y ` " y " . + I_�r * 4 x h: uy r eS 1 : al:.r , - .' . Fsi - : ., Gender: (91 LE ()FEMALE Ah T1 u'�. li Last Name: Vl/ J �J First Name:G MI: Home Address(include PO Box if applicable): -6 A, /d ?fl i.e// �- �-l I /_ City: 0 in Y'1 County: Oc 9/ -J Zip Code: 6 9«y . Home Phone Number: e 13— f'05`'W'17° Business Phone Number: 4/6 2 '- `3 9 ''c (/ Social Security'Number: _ _ - __ __ Drivers License Number&State:rE ,_ Date Of Birth: - Place Of Birth: :I4S9d G' /1) a, • ' • .av �az3 . xI - 7-.r,i`"";r2:a%4�,;. _. } x.:S ,' t;9G = zr � kY7'- T, ;i ,r�=r �3[.1 0�,.il:a au`G I4[' .I 1. [is i F! , s [,, ,t a tJ, . 1' r} y 1h [[ ,t .V d 5' t . I" . r. i F K ��„[,`k`s ,,,i,:„rs,�x 6,yZir '' y . [ w 3u y"4.6 J1tk G , r { yPd , ' 'S 4,a ' 'eb ;lw.,.. r _ dx_ ,130-� y A , ) aa z !L) y • 6 YES ONO , YP R ,Fte '- G F• ,., --rLflOili' t ' , 4,:i -tz e • Spouses Last Name: (,,I/S('J First Name: Icc/i y MI• Social Security Number: Drivers License Number&State:P 2- DateOf Birth: Place Of Birth: A/or'L -i I C � ' - - +4 •:ru_..d.'...3— i ` _{"'- -f R'n'-`7!_ --7 by 7"W:;f(,:-ram[ a I ;x'.� n=i s X Z1= ..i{ }\f r:-i Y�.�P F�� y 1�, ,,1 ! :'v t: •.,' I , �[-F- v� . �� ap Iti�!r �[ � 1 t t' t7r ': * J e , * :t ,yrk't w i,41 b P7 'td h ; F7r'c'. .3 i") , i s I rc.f s ' r+r p �.a k x 1C 1 , n�14 1, ' ,�+ '� �f 1 .: rcR'v 4 1'[.' 1 44rz.. ?`'S � t�a, ,, } IrA4 5 RU ;4;--;,,'fiVS Lyt J 5rG � , t � -h �.§ eM.� 1ky4a .aJ,I‘i f K .: 1� .! -it is z 3 .rJ,,d. „,,/ ti _.h4 L. r. � .1 1"n ! `. � .N, �u d;1� v CITY&STATE YEAR YEAR CITY&STATE YEAR YEAR FROM TO FROM TO 0 Al�h e-/ It 4,,.."" vox �'�'''r ar►lrg- e- hl� '`�Z '°'� %)9-')1,151— , --- Ao`o o2a l¢r,)no. �=L__. ,9deo ?`°!Z_. RECEIVED RECEIVED Form 103 Rev 11/2012 OCT 222012 OCT 4 2012 Pegs 3 of IVEBkHdl�e LAUUOR N�RI�SI LIQUOR CONTROL COM CONTROL COMMISSION MISSION FICER/MANAGING MEMBER SIGNATURE (Faxed signatures are acceptable) RECEIVED Rev Fel1/nn201 103 2 OCT 222012 r�eaoes (;ON1'R®1..C®MM 1200020184 • Revised i f2008 his application is available in other formats for persons with disabilities. A ten day advance period is required in writing to produce the alternate format. ' i=ECEIVE !: :: Form 103 OCT 112012 Rev1t/2012 Page s or s hr. �� LitaIUOR CONTROL COMMISSION 000 2012 • , . . :ri• _ r,ECElv Eli .,.: Form 103 OCT 1 1 niz Rev 11/2012 Page 3 of 5 WEBRASCIV4 LIQUOR CONTROL COMMISSION , . - . retary Form 103 Rev 11/2012 Page 2 of S 1200020151 �+, r f.-l:4: ttu �4� . f . ',,,, _ .1'o-uu k t_ JIG G ANt e' �..'-r•---i,6142v w11,7-k.Y4!"hi„--ra • YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE FROM TO NUMBER fga ca.)rt w�/ S-Avi v �l orb 607- 6 - occ7 2-" �1 '741d e A/67_ 70S-3"fa4 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 . isdemeanor,violation of a federal or state law;a violation of a local law, ordinance or resolution. List the t . the charge,where the charge occurred and the year and month of the conviction or plea. Also list any ..es pending at the time of this application. If more than one party,please list charges by each individual's. •e. YES 111, NO I yes,please explain be ow or attach a separate page. Name of Applicant Date of Where Description of Charge Disposition Conviction Convicted ( yyyy) (city&state) ( MWE". OCT4 ZOI2 CONYROLCO�AAA� 2. Have you or your spouse ever been approved •r made = .plication for a liquor license in Nebraska or any other state? OYES IF YES,list the name of the premise. 3. Do you,as a manager,qualify under Nebraska Liquor Control • (§53-131 01)and do you intend to supervise, in person,the management of the business? I4; C0 4. Have y. . enclosed the required fingerprint cards and PROPER FEES with this application? _h- or mone order made payable to the Nebraska State Patrol for$38.00 per person) lit U10 5. List any alcohol related traininand/or experience(when and where). d� 5/z3IZ,„ �JL � � - ' i�-f-r (et77) ('c(S-/— rS Form 103 RECEIVED Rev 11/2012 Pease of 3 OCT 222012 NEBRASKA utUUOR CONTROL COMMISSION v CITY&STATE YEAR YEAR CITY&STATE YEAR YEAR FROM TO FROM TO 0 Al�h e-/ It 4,,.."" vox �'�'''r ar►lrg- e- hl� '`�Z '°'� %)9-')1,151— , --- Ao`o o2a l¢r,)no. �=L__. ,9deo ?`°!Z_. RECEIVED RECEIVED Form 103 Rev 11/2012 OCT 222012 OCT 4 2012 Pegs 3 of IVEBkHdl�e LAUUOR N�RI�SI LIQUOR CONTROL COM CONTROL COMMISSION MISSION FICER/MANAGING MEMBER SIGNATURE (Faxed signatures are acceptable) RECEIVED Rev Fel1/nn201 103 2 OCT 222012 r�eaoes (;ON1'R®1..C®MM 1200020184 • Revised i f2008 his application is available in other formats for persons with disabilities. A ten day advance period is required in writing to produce the alternate format. ' i=ECEIVE !: :: Form 103 OCT 112012 Rev1t/2012 Page s or s hr. �� LitaIUOR CONTROL COMMISSION 000 2012 • , . . :ri• _ r,ECElv Eli .,.: Form 103 OCT 1 1 niz Rev 11/2012 Page 3 of 5 WEBRASCIV4 LIQUOR CONTROL COMMISSION , . - . retary Form 103 Rev 11/2012 Page 2 of S 1200020151 _ of§jgr nr x -,+ 1 rc�tl r" ♦ t •;, i t Nj; 4,- r 1� Ioarr, ( f it le k�c� Jy� i�l z 1 yr w1N ' "a}'1 ' � AG. t;,,,i,'VI :., 4 �b +w it 1 , '+c,c.{� 4 3 7 ,ydy.t } - eye 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. Si of Manager Applicant Signature of Spouse ACKNOWLEDGEMENT • State of Nebraska County of DI, The foregoing was acknowledged J � g instrument before me this cf�.- o. 20! l 2p e4�� Z by 76^r UtSe S me name of person acknowledged 1�� ' AM Seal �lotary Public signature ROTARY State of Mebtasta *gar vegre:Iniultergois 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. RECEN et) RCEVED oc/ 2 202 2012 j?ssiON OR oo� �REectwd l-i�t?s0soNR !:�l l�,z CON 1T commoL COO M Paga 5 of S . ,9deo ?`°!Z_. RECEIVED RECEIVED Form 103 Rev 11/2012 OCT 222012 OCT 4 2012 Pegs 3 of IVEBkHdl�e LAUUOR N�RI�SI LIQUOR CONTROL COM CONTROL COMMISSION MISSION FICER/MANAGING MEMBER SIGNATURE (Faxed signatures are acceptable) RECEIVED Rev Fel1/nn201 103 2 OCT 222012 r�eaoes (;ON1'R®1..C®MM 1200020184 • Revised i f2008 his application is available in other formats for persons with disabilities. A ten day advance period is required in writing to produce the alternate format. ' i=ECEIVE !: :: Form 103 OCT 112012 Rev1t/2012 Page s or s hr. �� LitaIUOR CONTROL COMMISSION 000 2012 • , . . :ri• _ r,ECElv Eli .,.: Form 103 OCT 1 1 niz Rev 11/2012 Page 3 of 5 WEBRASCIV4 LIQUOR CONTROL COMMISSION , . - . retary Form 103 Rev 11/2012 Page 2 of S 1200020151 SPOUSAL AFFIDAVIT OF Office Use 7ECEIVED NON:PARTICIPATION INSERT NEBRASKA LIQUOR CONTROL COMMISSION OCT 2 2 2012 301 PO BOX 9CFIJT CENTENNIAL MALL SO�iTH NE8flAS'1-0®KUOR LINCOI 68509.5046 CQNTROL COMMISSION PHONE:(402)(402)4712571 FAX:(402)4712814 Website: .www.icc.ne:aov I acknowledge lhat of ailiquor licenses der,l Any signatuteYbelowHconfir is that i haveen aver ► .t I Ili I` b.) 1 Iiop oA7. y { _ `t` ��<� �( s.; oti }�� n m4 ?R 0 Tr �FI ) t11 /l I i{ 1��Qj/r� n,��1ii, � fI 1�A�L�/ .'I • • 11{let ,i i ,y:-I i!<.n �s�i ! y +i dal i t .i f 1 oIce e is o, an g �� i i aT I Ir ).1 df r:^ l° 1 / , h s •i ? - c.. -4 . n �f'r � \ !�� C3 1 �i 1 1 .i,1�. r f3 �}Q�, II "' " F S�Sy:'',E � yi"-r 5�.�, h$Nt'S� yyy��, 'TIC , JV I 1 i1:� Y r i k 7� a r �i C i � :aPl3lioatt�»» L Ss .tiyi t i N kt S I&eiiy (Jig es igna f spouse asking for waiver Printed name of spouse asking for waiver (Spouse of individual listed below) State of NIQ,�t'Ag County of Do..)5 la 5 The foregoing instrument was acknowledged before me this ►(o'—` dog. oR Oc 64e- tole by Ke,11y V\Ses date name of person acknowledged t J Affix seal ..JJ CAL NOTARY-Stye of terra Notary ublic signature ; . A.Oa 2 — Comm My Comm.Dep. 18,Jan. 018 4. . r% led a x g K, p 'o fa f the by llndMduaL. un stand thstl i l spouse,and l are responsibl+for a. �compli lcb 1, i `° • • rele determined. t tbei�iii 1 !I violated(§53-124(13))the , o g'A .�,...-o - � V"`...,. .. � Si a of mdividual involved with application Printed ne of applying individual use of individual listed above) State of iV e�ra&kA - County of b0 tiyl‘? The foregoing instrument was acknowledged before me this 1L dQy , P Oc_A-eerZollz by Toohy v1 Sep date name of person acknowledged G(- Q .ti Affix Seal blic signature IssiesaBIERAL�TARII,S�e at Nebraska My Comm. �18,2015 In compliance with the ADA,this spousal affidavit of we participation Is available In other formats for persons with disabilities. A ten day advance period Is requested in writing to produce the alternate format. FORM 35.4178 Revised V2008 ures are acceptable) RECEIVED Rev Fel1/nn201 103 2 OCT 222012 r�eaoes (;ON1'R®1..C®MM 1200020184 • Revised i f2008 his application is available in other formats for persons with disabilities. A ten day advance period is required in writing to produce the alternate format. ' i=ECEIVE !: :: Form 103 OCT 112012 Rev1t/2012 Page s or s hr. �� LitaIUOR CONTROL COMMISSION 000 2012 • , . . :ri• _ r,ECElv Eli .,.: Form 103 OCT 1 1 niz Rev 11/2012 Page 3 of 5 WEBRASCIV4 LIQUOR CONTROL COMMISSION , . - . retary Form 103 Rev 11/2012 Page 2 of S 1200020151 �) 1 ]l,/77 �] ; , //e aro/ , 07 / Jib::,., 1819 Farnar—Suite LC 1 c` rJ ," f�� b r Omaha. Nebraska 681 83--01 1 2 `,e� --�. y `, ,,; I' ustev 5 rroucro (402) z 44-5550 ��,• • "_ �,�n, otv COevk FAX (402) 44 -52C e � • November 6, 2012 Granite City Restaurant Operations, Inc. Application to appoint Anthony B. Ulses Dba"Granite City Food &Brewery" manager of your present Class "C" and 1001 North 1.02" Street Class "L" 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 November 20, 2012 . 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 before me this ►(o'—` dog. oR Oc 64e- tole by Ke,11y V\Ses date name of person acknowledged t J Affix seal ..JJ CAL NOTARY-Stye of terra Notary ublic signature ; . A.Oa 2 — Comm My Comm.Dep. 18,Jan. 018 4. . r% led a x g K, p 'o fa f the by llndMduaL. un stand thstl i l spouse,and l are responsibl+for a. �compli lcb 1, i `° • • rele determined. t tbei�iii 1 !I violated(§53-124(13))the , o g'A .�,...-o - � V"`...,. .. � Si a of mdividual involved with application Printed ne of applying individual use of individual listed above) State of iV e�ra&kA - County of b0 tiyl‘? The foregoing instrument was acknowledged before me this 1L dQy , P Oc_A-eerZollz by Toohy v1 Sep date name of person acknowledged G(- Q .ti Affix Seal blic signature IssiesaBIERAL�TARII,S�e at Nebraska My Comm. �18,2015 In compliance with the ADA,this spousal affidavit of we participation Is available In other formats for persons with disabilities. A ten day advance period Is requested in writing to produce the alternate format. FORM 35.4178 Revised V2008 ures are acceptable) RECEIVED Rev Fel1/nn201 103 2 OCT 222012 r�eaoes (;ON1'R®1..C®MM 1200020184 • Revised i f2008 his application is available in other formats for persons with disabilities. A ten day advance period is required in writing to produce the alternate format. ' i=ECEIVE !: :: Form 103 OCT 112012 Rev1t/2012 Page s or s hr. �� LitaIUOR CONTROL COMMISSION 000 2012 • , . . :ri• _ r,ECElv Eli .,.: Form 103 OCT 1 1 niz Rev 11/2012 Page 3 of 5 WEBRASCIV4 LIQUOR CONTROL COMMISSION , . - . retary Form 103 Rev 11/2012 Page 2 of S 1200020151 71\n f,c) //A/N.\ ; 0\ q:)) ( an(71 ha 's e Tut 1819 Farnam Sup e LC .k Omaha, Nebraska 68 E33 r 1 tit ' 02 4-5550 Z November 6, 2012 • • • • Anthony B. Ulses Application to be appointed manager of the 2526 North 109`1' Terrace present Class "C" and Class "L" Liquor Apt #211 License location for Granite City Restaurant Omaha, NE 68114 Operations, Inc., dba "Granite City Food & Brewery", 1001 North 102' 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 November 20, 20112 e 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 . this ►(o'—` dog. oR Oc 64e- tole by Ke,11y V\Ses date name of person acknowledged t J Affix seal ..JJ CAL NOTARY-Stye of terra Notary ublic signature ; . A.Oa 2 — Comm My Comm.Dep. 18,Jan. 018 4. . r% led a x g K, p 'o fa f the by llndMduaL. un stand thstl i l spouse,and l are responsibl+for a. �compli lcb 1, i `° • • rele determined. t tbei�iii 1 !I violated(§53-124(13))the , o g'A .�,...-o - � V"`...,. .. � Si a of mdividual involved with application Printed ne of applying individual use of individual listed above) State of iV e�ra&kA - County of b0 tiyl‘? The foregoing instrument was acknowledged before me this 1L dQy , P Oc_A-eerZollz by Toohy v1 Sep date name of person acknowledged G(- Q .ti Affix Seal blic signature IssiesaBIERAL�TARII,S�e at Nebraska My Comm. �18,2015 In compliance with the ADA,this spousal affidavit of we participation Is available In other formats for persons with disabilities. A ten day advance period Is requested in writing to produce the alternate format. FORM 35.4178 Revised V2008 ures are acceptable) RECEIVED Rev Fel1/nn201 103 2 OCT 222012 r�eaoes (;ON1'R®1..C®MM 1200020184 • Revised i f2008 his application is available in other formats for persons with disabilities. A ten day advance period is required in writing to produce the alternate format. ' i=ECEIVE !: :: Form 103 OCT 112012 Rev1t/2012 Page s or s hr. �� LitaIUOR CONTROL COMMISSION 000 2012 • , . . :ri• _ r,ECElv Eli .,.: Form 103 OCT 1 1 niz Rev 11/2012 Page 3 of 5 WEBRASCIV4 LIQUOR CONTROL COMMISSION , . - . retary Form 103 Rev 11/2012 Page 2 of S 1200020151 [ , I / 9 7 \n e 7 F' r o / / o 2 • C 7n � IQ q® r q m ez / n -• E d - 0 7 c m , sA . - r• ® § 4=ii. HiF a CD k ¢ 6. o w.� r) \ • \ /. -t ¢ -t 7 — � G � Ui; maha, NE (#C76553). Worked purchasing liquor and food supplies, barkeeper and internal accountant. RSCE/Ist OCT °0? iT 4-,•i• , • `,• • • • ,:cjON ( / 7 -Z i< U 7 S) 7--(— &-97CtP66 0/ 7 � o /c13 •