RES 2012-0100 - Appoint Jessica L Reutter manager of Field Club of Omaha STATE OF NEBRASKA
'D' Dave Heineman NEBRASKA LIQUOR CONTROL COMMISSION
 Governor t . Hobert B. Rupe
Executive Director
Il tv 9RQ; ga` /I 23
8: y ' 301 Centennial Mall South, 5th Floor
'�t I P.O.Box 95046
Lincoln,Nebraska 68509-5046
.. .. Phone(402)471-2571
Fax(402)471-2814 or(402)471-2374
December 21, 2011 l 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: Field Club of Omaha
LICENSE #C-92639
Dear Clerk:
Enclosed is a copy of a manager application for Jessica L. Reutter in connection with the Field Club of
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
402-471-2572_
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
ecommend denial of your
application to the Nebraska Liquor Control Commission.
Sincerely yours, •
Buster Brown
City Clerk
BJB:clj
rstand that my spouse and I are responsible for
compliaiice 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.
171040 i4q\I -30C l 4)0
SIa ature uf individual involved with application Prin d ne of applying individual
(Spouse o individual listed above)
State of Q,�q
County of \bbqic."45 e fore oing instrument was acknowledged before me this
Iby r//y �C Pl aname of pe n acknowledged
Affix Seal ,( •StIMo1N•tart'Pature MAR Y F.SCHNEIDER
Coate= fel.1.2015
In compliance with the ADA,this spousal affidavit of non 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 1/2008
NE 2004 Present
9622 Spaulding Street,Omaha,NE 1999 2004 9622 Spaulding Street,Omaha,NE 1999 2004
Form 103
Rev 11/2012
Page 3 of 5
MANAGER APPLICATION omoo Use
•
INSERT-FORM3c RECEIVED
NEBRASKA LIQUOR CONTROL COMMISSION
301 CENTENNIAL MALL SOUTH DEC 212011
L BOX 95046
NEBRASKA LIQUOR
LINCOLN,
68309=5046
NE
PHONE: (402)471-2571 CONTROL COMMISSION
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
• 4) Must submit their fingerprints(2 cards per person)and fees of$38 per person,made payable to
the Nebraska State Patrol
• 5) Must be 21 years of age or older
6) Applicant may be required to take a training.course
•
Name of Corporation/LLC: gQ �11., 1 V ekrasic �Jt:,o,e..Arci u�.
.......
J
;Premise,information' •• :•• .
. ,: . .
•.
•' •• . • S �
• Premiss e License Number: : ) .;Qa‘34 (,;
if n w app icatio ve blank) .
Premise Trade Name/DBA: �C1¢,lti ( '0 Ovvtank.
Premise Street Address: 3(a15 W OO I 0 r- t'k 1L...
City: Oy'If^1ati/L.lti State: NE Zip Code: (i I c S
LI �J. �D
Premise Phone umber: "I�o� �J� 3
N L-f,
The individual whose name is listed as a corporate officer or managing member as reported on Insert form 3a
or 3b must sign their name below
•
&C%-i Al. ' ' V.G /?M4JJ4A ->
COR:a 'FE OFFICER/MANAGING MEMBER SIGNAT
(Faxed signatures are acceptable)
Form 103
_ Rev 1/2011
1111 I II II Page 2 of S
1100020960
Coate= fel.1.2015
In compliance with the ADA,this spousal affidavit of non participation is available in other formats for persons with disabilities.
A ten day advance period is requested in writing to produce the alternate format.
FORM 35-4178
Revised 1/2008
NE 2004 Present
9622 Spaulding Street,Omaha,NE 1999 2004 9622 Spaulding Street,Omaha,NE 1999 2004
Form 103
Rev 11/2012
Page 3 of 5
- KtLLIVED
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Gender: 0 MALE %FEMALE CONTROL COMMISSION
Last Name: ege ,*.ems First Name: c1ISS l Ca_ MI:±
Home Address(include PO Box if applicable): 1 Li Odl � re.e_O�
City: County: SOLrpL( Zip Code: (0$C D-2
Home Phone Number: q I . (o g 1,32{S�( Business Phone Number: 14 0 a •3 Lt rJ• Co 3 43
Social Security Number: _ _ `Drivers License Number& State: _)A\IE
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y
Date Of Birth:-,. 1 r.-- ,- , Place Of Birth: )e hie_ j C- o
ire ypu ed .if ye ''l i spouse' r rrmation(E e>tt`'tas iisat a��h been sulb i"itted) { _
spar. y L.2 � 3 a}. to�y it,r4Y``IC: . iA 3 - fi
IYES ❑NO
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Spouses Last Name: RL,wft.Qir First Name: Ph; (Up MI:
Y
Social Security Number: _ . _ Drivers License Number&State: 3
Date Of Birth: - - Place Of Birth: }k u..,b o 1+ To W q
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CITY&STATE YEAR YEAR CITY&STATE YEAR YEAR
FROM TO FROM TO
D1ilcS a oa5:20!1 Dva a.r+d PccxtcI Ks aoo5 cR of f
VV12. 2s j C pegFi_. a 003 aobS atYCJ FL 1003 ai Form 103
Rev 1/2011
' Page3of5
•
• :,• 7v isfAag 4-t R'S' • S
YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE
FROM TO NUMBER
saDii L' P ��; L.esc h.c,c_IC 316.101.18• 9.143
Iga�f aoo°r 0(.0oCorp 8+1,ve,60tle li c q•?a.c1961.305
ylpiAGPR AND:SPOUSENI,ST`IEVIEW AND ANSWER'1:11 WES'TIONS BELOW w ::
Ple print .441
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 the year and month of the
conviction or plea. Also list an charges pending at the time of this application. If more than one party,please list
charges by each individual's ame.
YES NO
If yes,please explain below or attach a separate page.
Name of Applicant Date of Where Description of Charge Disposition
Conviction Convicted
(mm/yyyy) (city&state) RECEIVED
DEC 212011
NEB RASKA 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 21O
IF YES,list the name of the premise.
3. Do you,as a manager,qualify under Nebraska Liquor Control ct(§53-131.01)and do you intend to
supervise,in person,the management of the business? 1YES ONO
4. Have you enclosed the required fingerprint cards and PROPER FEES with this application?
(C ck or money order made payable to the Nebraska State Patrol for$38.00 per person)
[!YES ONO
Form 103
Rev 1/2011
Page 4 of S
Y
Social Security Number: _ . _ Drivers License Number&State: 3
Date Of Birth: - - Place Of Birth: }k u..,b o 1+ To W q
—
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CITY&STATE YEAR YEAR CITY&STATE YEAR YEAR
FROM TO FROM TO
D1ilcS a oa5:20!1 Dva a.r+d PccxtcI Ks aoo5 cR of f
VV12. 2s j C pegFi_. a 003 aobS atYCJ FL 1003 ai Form 103
Rev 1/2011
' Page3of5
RECEIVED
••
DEC 212011
6
7:e.5 .. a. 7 �77e,N M1vry1:E';oa Sd•NA A._.,-Ti..Aa: .. d C O'NSt 4 F INvESTIGA k
AS KA'LIQU0
,t n dR � 4 il �N
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.
ignature of a Applicant Signature of Spouse
ACKNOWLEDGEMENT
State of Nebraska
County of Petiu eg..4 The foregoing instrument was acknowledged before me this
N//b/ fir J"esi aet Pea 1TE k.
date name of person acknowledged
S GEERAL NOTARY-Stool*bole
Notary Public signature !'; WIIJJAM F.WADE
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 1R011
Page 5 of 5
r rr 4. 4'3tir+ x -..,,-v T lqA � ftA� 4 � J+N1 J Y5G�i � :t a.t 5. z ,:,. N ' q ; 3.
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✓,-4•
CITY&STATE YEAR YEAR CITY&STATE YEAR YEAR
FROM TO FROM TO
D1ilcS a oa5:20!1 Dva a.r+d PccxtcI Ks aoo5 cR of f
VV12. 2s j C pegFi_. a 003 aobS atYCJ FL 1003 ai Form 103
Rev 1/2011
' Page3of5
[,•:','Print Ftion
SPOUSAL AFFIDAVIT OF c'ffice lise RECEIVED
NON PARTICIPATION INSERT
NEBRASKA LIQUOR CONTROL COMMISSION DEC 2 12011
301 CENTENNIAL MALL SOUTH
PO BOX 95046
LINCOLN,NE 68509-5046 NEBRASKA LIQUOR
PHONE:(402)471-2571
FAX:(402)471-2814 CONTROL COMMISSION
Website: www.Icc.ne.gov
;IliclmoWledge that I,ain the spousiof iiiiquor license holder. My signature below Confirnis 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
*wired;howeverI am obligated to sign and disclose any information on all applications needed to process this
. , • • ' • .
\k -PIK-tytie \A-t QUItteAr
Signature of spouse asking for waiver Printed name f spouse asking for waiver
(Spouse of individual listed below)
State of 171/4-4.44-tAa_
County of The foregoing instrument was acknowledged before me this
Q//0 // by Ph( ittp I-1 Qe-it -77-e...v•
date name offserson aelmbwledged
a4. Affix Saw
GENERAL NOTARY-State al Nebraska
WILLIAM F.WADE
otary Public signature
My Comm.Eio.Joie 4,2013
IONic-v-ledge that I atthe spouse oftheitbovelisied indiVicTual. UrKleistand that tny spouse and I are risiOnsible-for
1compliance with the conditions set out above. If it is determined that the above individual has violated(§53-125(13))the
C;iilininission may cancel or revoke the liquor license.
c;le 2,464 jzS5i ca- C-.
Si ature of individual i vo ed with application Printed name of applying individual
ouse of individual li above)
State of
County of 9 _ The foregoing instrument was acknowledged before me this
/ //0/1/ I by - .-eSfcdt). gel,( 778
/ date name of person acknowledged
0--LePidetb,l'a6e6- Affix
GENERAL NOTARY Stale of Nebraska'
Notary Public signature MINA F.WADE
My Went Exp.June 4,2013
In compliance with the ADA,this spousal affidavit of non 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 1/2008
FROM TO
D1ilcS a oa5:20!1 Dva a.r+d PccxtcI Ks aoo5 cR of f
VV12. 2s j C pegFi_. a 003 aobS atYCJ FL 1003 ai Form 103
Rev 1/2011
' Page3of5
City of Omaha, fl'slebraskgord
vtviaa,
.t)
1819 Farnam—Suite LC 1 • n�p �a r
Omaha, Nebraska 68183-0112 0�: � '
Buster Brown (402) 444-5550 ti'
A
0
City Clerk FAX (402) 444-5263 4,, FEBOUNC�
January 10, 2012
Eagle Nebraska Beverage, LLC Application to appoint Jessica L. Reutter
Dba"Field Club of Omaha" manager of your present Class "C" Liquor
3615 Woolworth Avenue License location
Omaha,NE 68105
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. January 24, 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,
if44/
Buster Brown
City Clerk
BJB:clj
WILLIAM F.WADE
otary Public signature
My Comm.Eio.Joie 4,2013
IONic-v-ledge that I atthe spouse oftheitbovelisied indiVicTual. UrKleistand that tny spouse and I are risiOnsible-for
1compliance with the conditions set out above. If it is determined that the above individual has violated(§53-125(13))the
C;iilininission may cancel or revoke the liquor license.
c;le 2,464 jzS5i ca- C-.
Si ature of individual i vo ed with application Printed name of applying individual
ouse of individual li above)
State of
County of 9 _ The foregoing instrument was acknowledged before me this
/ //0/1/ I by - .-eSfcdt). gel,( 778
/ date name of person acknowledged
0--LePidetb,l'a6e6- Affix
GENERAL NOTARY Stale of Nebraska'
Notary Public signature MINA F.WADE
My Went Exp.June 4,2013
In compliance with the ADA,this spousal affidavit of non 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 1/2008
FROM TO
D1ilcS a oa5:20!1 Dva a.r+d PccxtcI Ks aoo5 cR of f
VV12. 2s j C pegFi_. a 003 aobS atYCJ FL 1003 ai Form 103
Rev 1/2011
' Page3of5
•
City of Omaha, J\lebras&a I
ri z6, sa
1819 Farnam—Suite LC 1
Omaha, Nebraska 68183-0112 oA: ;�.... ;. _.
Buster Brown (402) 444-5550
City Clerk FAX (402) 444-5263 o�'TEp FEBRv�44
January 10, 2012
Jessica L. Reutter Application to be appoint manager of the Class "C"
19409 Josephine Street Liquor License location for Eagle Nebraska Beverage,
Gretna, NE 68028 LLC, dba"Field Club of Omaha", 3615 Woolworth
Avenue, Omaha,NE
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 January 24, 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,
Lit4
Buster Brown
City Clerk
BJB:clj
own
City Clerk
BJB:clj
WILLIAM F.WADE
otary Public signature
My Comm.Eio.Joie 4,2013
IONic-v-ledge that I atthe spouse oftheitbovelisied indiVicTual. UrKleistand that tny spouse and I are risiOnsible-for
1compliance with the conditions set out above. If it is determined that the above individual has violated(§53-125(13))the
C;iilininission may cancel or revoke the liquor license.
c;le 2,464 jzS5i ca- C-.
Si ature of individual i vo ed with application Printed name of applying individual
ouse of individual li above)
State of
County of 9 _ The foregoing instrument was acknowledged before me this
/ //0/1/ I by - .-eSfcdt). gel,( 778
/ date name of person acknowledged
0--LePidetb,l'a6e6- Affix
GENERAL NOTARY Stale of Nebraska'
Notary Public signature MINA F.WADE
My Went Exp.June 4,2013
In compliance with the ADA,this spousal affidavit of non 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 1/2008
FROM TO
D1ilcS a oa5:20!1 Dva a.r+d PccxtcI Ks aoo5 cR of f
VV12. 2s j C pegFi_. a 003 aobS atYCJ FL 1003 ai Form 103
Rev 1/2011
' Page3of5
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