RES 2012-0331 - Appoint Walter H Harrold manager of Elks O�,i E STq T�11,11y'
21,,
. STATE OF NEBRASKA
4 . RECEIVED D
NEBRASKA LIQUOR
UOR CONTROL COMMISSIONt ,, a Y 4y"; ',aye Heineman
T (-2 v''' Governor Hobert B. Rupe
; -�ab` / FEB ��+{:. 50Executive Director
12 B 14 OM 8:
301 Centennial Mall South,5th Floor
P.O. Box 95046
Lincoln,Nebraska 68509-5046
CITY CLERK Phone(402)471-2571
February 10, 2012 OMAHA,A A, EA K 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: ELKS BP() Iroquois Lodge 92 W
LICENSE #C-01338
Dear Clerk:
Enclosed is a copy of a manager application for Walter H. Harrold in connection with the Elks 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,
•
Cial--er12-.. • dd-411-LP--/7
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
y in person and acknowledged that he signed and delivered
the said instrument as his own free and voluntary act, for the uses
and purposes therein set forth.
GIVEN under my hand and notarial seal this day of
January, 2012 .
Notary Public
GENERAL NOTARY-Stale of Nebraska
DOREEN M.REHUREK
-�, - My Comm.Exp.April 2,2014
5
its successors and assigns, and any
arrears thereof, and will forthwith faithfully perform and fulfill
all of such terms, covenants, conditions and provisions, and will
forthwith pay to the. Landlord all damages that may arise in
consequence of any default by the Tenant, its successors and
assigns under said Lease, including, without limitation, all
reasonable attorneys ' fees incurred by the Landlord or caused by
any such default and/or by the enforcement of this Guaranty.
This Guaranty is an absolute and unconditional Guaranty of
payment and of performance. It shall be enforceable against the
Guarantor, its successors and assigns, without the necessity for
any suit or proceedings on the Landlord' s part of any kind or
nature whatsoever against the Tenant, its successors and assigns,
and without the necessity of any notice of non-payment, non-
performance or non-observance or any notice of acceptance of this
Guaranty or any other notice or demand to which the Guarantor might
otherwise be entitled, all of which the Guarantor hereby expressly
waives; and the Guarantor hereby expressly agrees that the validity
of this Guaranty and the obligations of the Guarantor hereunder
shall in no way be terminated, affected or impaired by reason of
the assertion or the failure to assert by the Landlord against the
Tenant, or the Tenant' s successors and assigns, of any of the
4
*
MANAGER APPLICATION Office Use
INSERT-FORM 3c
NEBRASKA LIQUOR CONTROL COMMISSION
301 CENTENNIAL MALL SOUTH RECEIVED
C C C'Vc
PO BOX 95046 f IG
LINCOLN,NE 68509-5046
PHONE (402)471-2571 FEB 1 2012
FAX: (402)471-2814 NEBRASKA LIQUOR
Website: www.(cc.ne.gov CONTROL COMMISSION
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 their fingerprints(2 cards per person)and fees of$38 per GNy6reto
the Nebraska State Patrol
5) Must be 21 years of age or older 1 Q 2,012
6) Applicant may be required to take a training course F Ed R
ova1 610N
Name of Corporation/LLC: ���j g ,6/0..„z,e()@ (A a z,c)
Premise License Number:
(if new a plication leave blank)
Premise Trade Name/DBA:
Premise Street Address: 2Y�2 c' 2r4/ 5
City: 9,' -1 Ciao State: /, Zip Code: ////
Premise Phone Number: y5 -/,5,•.3F
The individual whose name is listed as a corporate officer or managing member as reported on insert form 3a
or 3b must sign their name below
11,
•
ViRP FF NAGING MEMBER SIGNATURE
(Faxed signatures are acceptable)
E E E Form 103
ev 1/2011
age 2 of 5
1200002451
forth.
GIVEN under my hand and notarial seal this day of
January, 2012 .
Notary Public
GENERAL NOTARY-Stale of Nebraska
DOREEN M.REHUREK
-�, - My Comm.Exp.April 2,2014
5
its successors and assigns, and any
arrears thereof, and will forthwith faithfully perform and fulfill
all of such terms, covenants, conditions and provisions, and will
forthwith pay to the. Landlord all damages that may arise in
consequence of any default by the Tenant, its successors and
assigns under said Lease, including, without limitation, all
reasonable attorneys ' fees incurred by the Landlord or caused by
any such default and/or by the enforcement of this Guaranty.
This Guaranty is an absolute and unconditional Guaranty of
payment and of performance. It shall be enforceable against the
Guarantor, its successors and assigns, without the necessity for
any suit or proceedings on the Landlord' s part of any kind or
nature whatsoever against the Tenant, its successors and assigns,
and without the necessity of any notice of non-payment, non-
performance or non-observance or any notice of acceptance of this
Guaranty or any other notice or demand to which the Guarantor might
otherwise be entitled, all of which the Guarantor hereby expressly
waives; and the Guarantor hereby expressly agrees that the validity
of this Guaranty and the obligations of the Guarantor hereunder
shall in no way be terminated, affected or impaired by reason of
the assertion or the failure to assert by the Landlord against the
Tenant, or the Tenant' s successors and assigns, of any of the
4
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`,'! r•i !1-r R(1 �F'tz10 s °0� ..tE:.,,: r.ta 'r:rl S�tkI� S s; 1 1 .1 - ��. r a� ��-�•k1`4.•
Gender: r MALE FEMALE �•a-� :,,1_1�QUOR
N
�Last Name: /10/1/1 First Name: �
/� . 2-9)
Home Address(include PO Box if applicable): (.//�:..�
City: OJ922IO County Zip Code: doP///
Home Phone Number' 4.1/5/4VBdsiness Phone Number:
Social Security Number _ _ _ _ Drivers License Number 8/ Tate
Date Of Birth: , _ _ Place Of Birth: /2V
•
,, r• .
•
•Cp YES fh NO
fED 1 2012
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
Oritolo
8, n '9o" 1VJ/.q41g7
Form 103
Rev 1/2011
Page 3 of 5
ense Number:
(if new a plication leave blank)
Premise Trade Name/DBA:
Premise Street Address: 2Y�2 c' 2r4/ 5
City: 9,' -1 Ciao State: /, Zip Code: ////
Premise Phone Number: y5 -/,5,•.3F
The individual whose name is listed as a corporate officer or managing member as reported on insert form 3a
or 3b must sign their name below
11,
•
ViRP FF NAGING MEMBER SIGNATURE
(Faxed signatures are acceptable)
E E E Form 103
ev 1/2011
age 2 of 5
1200002451
forth.
GIVEN under my hand and notarial seal this day of
January, 2012 .
Notary Public
GENERAL NOTARY-Stale of Nebraska
DOREEN M.REHUREK
-�, - My Comm.Exp.April 2,2014
5
its successors and assigns, and any
arrears thereof, and will forthwith faithfully perform and fulfill
all of such terms, covenants, conditions and provisions, and will
forthwith pay to the. Landlord all damages that may arise in
consequence of any default by the Tenant, its successors and
assigns under said Lease, including, without limitation, all
reasonable attorneys ' fees incurred by the Landlord or caused by
any such default and/or by the enforcement of this Guaranty.
This Guaranty is an absolute and unconditional Guaranty of
payment and of performance. It shall be enforceable against the
Guarantor, its successors and assigns, without the necessity for
any suit or proceedings on the Landlord' s part of any kind or
nature whatsoever against the Tenant, its successors and assigns,
and without the necessity of any notice of non-payment, non-
performance or non-observance or any notice of acceptance of this
Guaranty or any other notice or demand to which the Guarantor might
otherwise be entitled, all of which the Guarantor hereby expressly
waives; and the Guarantor hereby expressly agrees that the validity
of this Guaranty and the obligations of the Guarantor hereunder
shall in no way be terminated, affected or impaired by reason of
the assertion or the failure to assert by the Landlord against the
Tenant, or the Tenant' s successors and assigns, of any of the
4
•
YEAR NAME OF EMPLOYER NAME OF SUPERVISOR •5.P :ONE
FROM TO _ / _ pE-Cj 1 • I:ER
0 QR
15�0 I'999 I o/Lc/e ,Eth&ii . , j� is *;®N
. S 1,►y !±fir � vvv��� r�
S e 1�v p ( c1+,4. of I �,b 6\jib"1.10'�b vt r)}' ,` M1f , �, Y'�. i .S.f,�� i•no +� r•,�
•
0fi. y�s -?���t iJ4 w • �4�. � r' 'ia� v. rs.,1. *4!`�
1. READ CAREFULLY. ANSWER COMPLETELY AND ACCURATELY.
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 -.- and month of the
conviction or plea. Also list an harges pending at the time of this application. If m ylist
charges by each individual's me. (J
❑ YES NO FEB
If yes,please explain below or attach a separate page. 1 2012
Name of Applicant Date of Where Descrip •t e K 11 1Q$�ition
• Conviction Convicted ����''ttCt�)LQM
tSSrON
(mm/yyyy) (city&state)
•
•
2. Have you or your spouse ever been approved or a application for a liquor license in Nebraska or
any other state? DYES O
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? S ONO
4. Have you enclosed the required fingerprint cards and PROPER FEES with this application?
(Ch or money order made payable to the Nebraska State Patrol for$38.00 per person)
S ONO
Form 103
Rev 1/2011
Page 4 of 5
forthwith faithfully perform and fulfill
all of such terms, covenants, conditions and provisions, and will
forthwith pay to the. Landlord all damages that may arise in
consequence of any default by the Tenant, its successors and
assigns under said Lease, including, without limitation, all
reasonable attorneys ' fees incurred by the Landlord or caused by
any such default and/or by the enforcement of this Guaranty.
This Guaranty is an absolute and unconditional Guaranty of
payment and of performance. It shall be enforceable against the
Guarantor, its successors and assigns, without the necessity for
any suit or proceedings on the Landlord' s part of any kind or
nature whatsoever against the Tenant, its successors and assigns,
and without the necessity of any notice of non-payment, non-
performance or non-observance or any notice of acceptance of this
Guaranty or any other notice or demand to which the Guarantor might
otherwise be entitled, all of which the Guarantor hereby expressly
waives; and the Guarantor hereby expressly agrees that the validity
of this Guaranty and the obligations of the Guarantor hereunder
shall in no way be terminated, affected or impaired by reason of
the assertion or the failure to assert by the Landlord against the
Tenant, or the Tenant' s successors and assigns, of any of the
4
RECEIVED
•
~r+ :x t j A } S 'fib 4s I • �� ,�•�i. v�i� yi"'x �_�i, .F` -
•
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•^ �• [ i' - a •"f• •.i ", `��'+'�
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..
• i4.
Signature of Manager A.:licant Signature of Spouse
ACKNOWLEDGEMENT
State of Nebraska
County of VDU 6 L/t The foregoing instrument was acknowledged before me this
TihULt q 4/ by WILT /7 /9—A2,0 L,[
/ date name of person acknowl ged
_ Affix Seal a
Notary Public signature BUSTER J.BROWN
*Waft P4 4 30,2°13
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 1/2011
Page 5 of 5
of any default by the Tenant, its successors and
assigns under said Lease, including, without limitation, all
reasonable attorneys ' fees incurred by the Landlord or caused by
any such default and/or by the enforcement of this Guaranty.
This Guaranty is an absolute and unconditional Guaranty of
payment and of performance. It shall be enforceable against the
Guarantor, its successors and assigns, without the necessity for
any suit or proceedings on the Landlord' s part of any kind or
nature whatsoever against the Tenant, its successors and assigns,
and without the necessity of any notice of non-payment, non-
performance or non-observance or any notice of acceptance of this
Guaranty or any other notice or demand to which the Guarantor might
otherwise be entitled, all of which the Guarantor hereby expressly
waives; and the Guarantor hereby expressly agrees that the validity
of this Guaranty and the obligations of the Guarantor hereunder
shall in no way be terminated, affected or impaired by reason of
the assertion or the failure to assert by the Landlord against the
Tenant, or the Tenant' s successors and assigns, of any of the
4
0,4„k„A, Art _
city ® Omaha, ,e6ras °��
1819 Farnam Suite LC 1 n® r '(l,
Omaha, Nebraska 68183-0112 0ito': � ' _
Buster Brown (402) 444-5550 iO
City Clerk FAX (402) 444-5263 oR'4'D fiE$R '.��
February 22, 2012
Elks BPO Iroquois Lodge 92W Application to appoint Walter.H. Harrold
Dba"Elks" . manager of your present Class "C"
2420 Lake Street Liquor License location
Omaha,NE 68111
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 March 6, 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
rmation submitted in
this application, is subject to cancellation if the information contained herein is incomplete, inaccurate, or
• fraudulent..
• i4.
Signature of Manager A.:licant Signature of Spouse
ACKNOWLEDGEMENT
State of Nebraska
County of VDU 6 L/t The foregoing instrument was acknowledged before me this
TihULt q 4/ by WILT /7 /9—A2,0 L,[
/ date name of person acknowl ged
_ Affix Seal a
Notary Public signature BUSTER J.BROWN
*Waft P4 4 30,2°13
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 1/2011
Page 5 of 5
of any default by the Tenant, its successors and
assigns under said Lease, including, without limitation, all
reasonable attorneys ' fees incurred by the Landlord or caused by
any such default and/or by the enforcement of this Guaranty.
This Guaranty is an absolute and unconditional Guaranty of
payment and of performance. It shall be enforceable against the
Guarantor, its successors and assigns, without the necessity for
any suit or proceedings on the Landlord' s part of any kind or
nature whatsoever against the Tenant, its successors and assigns,
and without the necessity of any notice of non-payment, non-
performance or non-observance or any notice of acceptance of this
Guaranty or any other notice or demand to which the Guarantor might
otherwise be entitled, all of which the Guarantor hereby expressly
waives; and the Guarantor hereby expressly agrees that the validity
of this Guaranty and the obligations of the Guarantor hereunder
shall in no way be terminated, affected or impaired by reason of
the assertion or the failure to assert by the Landlord against the
Tenant, or the Tenant' s successors and assigns, of any of the
4
•
OpHA, N4, ..
City ofOmaha, Webraskg �� 1'1' 4�T,
,ffr,A.Irdetri N)
1819 Farnam Suite LC 1
Omaha, Nebraska 68183-0112 0 -;....` ` -, •
Buster Brown (402) 444-5550 i6 �
City Clerk FAX (402) 444-5263 O 4
R'��D FEBR°'+
February 22, 2012
Walter H. Harrold Application to be appoint manager of the Class
4451 Kansas Street "C" Liquor License locations for Elks BPO
Omaha,NE 681.11 Iroquois Lodge 92W dba"Elks", 2420 Lake 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 March 6, 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, . -
•
4•1‘
Buster Brown
City Clerk '
BIB:clj '
-
nt..
• i4.
Signature of Manager A.:licant Signature of Spouse
ACKNOWLEDGEMENT
State of Nebraska
County of VDU 6 L/t The foregoing instrument was acknowledged before me this
TihULt q 4/ by WILT /7 /9—A2,0 L,[
/ date name of person acknowl ged
_ Affix Seal a
Notary Public signature BUSTER J.BROWN
*Waft P4 4 30,2°13
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 1/2011
Page 5 of 5
of any default by the Tenant, its successors and
assigns under said Lease, including, without limitation, all
reasonable attorneys ' fees incurred by the Landlord or caused by
any such default and/or by the enforcement of this Guaranty.
This Guaranty is an absolute and unconditional Guaranty of
payment and of performance. It shall be enforceable against the
Guarantor, its successors and assigns, without the necessity for
any suit or proceedings on the Landlord' s part of any kind or
nature whatsoever against the Tenant, its successors and assigns,
and without the necessity of any notice of non-payment, non-
performance or non-observance or any notice of acceptance of this
Guaranty or any other notice or demand to which the Guarantor might
otherwise be entitled, all of which the Guarantor hereby expressly
waives; and the Guarantor hereby expressly agrees that the validity
of this Guaranty and the obligations of the Guarantor hereunder
shall in no way be terminated, affected or impaired by reason of
the assertion or the failure to assert by the Landlord against the
Tenant, or the Tenant' s successors and assigns, of any of the
4
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