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RES 2011-0472 - Appoint Teresa M Porter manager of Crowne Plaza Hotel STATE OF NEBRASKA , ; >~ ; Dave Heineman NEBRASKA LIQUOR CONTROL COMMISSION 7 Governor Hobert B. Rupe Executive Director It VIR 1 r. 301 Centennial Mall South. 5th Floor P.O. Box 95046 Lincoln. Nebraska 68509-5046 CITY C L . K Phone (402) 471-2571 0'1 . I�E;31W � Fax (402)471-2814 TRS USER 800 833-7252 (TTY) March 23, 2011 OMAHA CITY CLERK 1819 FARNAM STREET OMAHA NE 68183 RE: MANAGER APPLICATION License: #C-83962 Dear Clerk: Enclosed is a copy of a manager application for Teresa Porter in connection with Crowne Plaza Hotel, 655 N 108th Ave. Please present this application for manager to your City Council and send us the results of their action. Sincerely, NEBRASKA ►e U•R CONTROL COMMISSION / "andy eybe Licensing Division rs encl. cc: file lanic Wiebusch Bob Logsdon Bob Batt Commissioner Chairman Commissioner An Equal Opportunity/Affirmative Action Employer BE MADE. ies, 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. If you are making changes to the type of business or the type of activities that will be operated on the new premises. Please complete and return the attached. Ordinance No. 37046, passed June 7, 2005, requires each applicant to submit a written statement describing all types of business or activities that will be operated on the premises in conjunction with the proposed license. Attached is the statement to be signed and returned (hand deliver, mail or fax) to the City Clerk's Office 7 days in advance of the public hearing. Sincerel yours, . ' Buster Brown City Clerk BJB:clj rty room d. Install grab bar in bathroom(per code) e. Leave existing FRP in bathroom or wall preventing the uncontrolled entrance or exit of persons from the premises,and preventing the passing of alcoholic liquors to persons outside the premises. (examples may include, but are not restricted to sand volleyball,horseshoe pits...) 1 1 Ck -71 D -- 14S--Lib or\ Tc- -1 t MANAGER APPLICATION oim Use • INSERT-FORM 3c NEBRASKA LIQUOR CONTRO !t it ISSION 301 CENTENNIAL MALL SO EIVED IVI A4 2O1`� PO BOX 95046 LINCOLN,NE 68509-5046 ������ LIQUOR(402)471 2571 MAR 1 4 201' FAX:(402)471 2814 RQ��Ww�_ rZ94c nn r�niana�� oan�� Website:www.lcc.ne.lrov NEBRASKA LIQUOR Corporate manager,including Cariii1014MICAKM 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$38 per person,made payable to the Nebraska State Patrol 5) Must be 21 years of age or older 6) Applicant may be required to take a training course ,.. E t .w. ,<_-..�., .... ,_.,.�:.�:_..:_ >>,�, - o-c o+�J 3 r� v� ) 1� all .� 11F�z - - = �_ .J�:: ::-,A - fig r x-. .+r,: .r ruc..A$^ .(.,�1�, 1 fii. .�� : . '� a . ._...i,�i mot. _ ., _ .... ..., .•.��.. >.... ...__✓.�.. ....> .. ,. �.. ... .. ., c3'. Name of Corporation/LLC: -OMAHA,INC. • "-.0 1 l a I f 0 1 ell}'�Y - a / r ; ' •.�,i'. �._ S ��n . �'c� $ i .� ` YE - 4y 1 !��r y> 1 Premise License Number: 'xc' ' (if new application leave blank) Premise Trade NameIDBA: OHOWHE PLAZA HOTEL Premise Street Address: 655 N. 108 Ave City. Omaha State: NE Zip Code:68154 Premise Phone Number:402488-0850 The individual whose name is listed as a corporate officer or managing member as reported on insert form 3a dior 3their name blow ..c..., .a/-(4. L...._ . CORPORATE OFFICER/MANAGING MEMBER SIGN TUBE (Faxed signatures are acceptable) Faun 103 Rav U2011 Page 2 of 5 1100004027 a stricted to sand volleyball,horseshoe pits...) 1 1 Ck -71 D -- 14S--Lib or\ Tc- -1 MAR 14 2011 [ ER rumo'^i ?�i i Y� i i ::c��' SI:�Y� ' l �'� -.y's ' '_ �ti tifocu . ii 1 r r7 Gender: 0 MALE ©FEMALE NEBRAS&sA LIQUOR CONTROLCOMMl om Last Name:Porter First Name:Teresa MI:I Home Address(include PO Box if applicable):15657 Sahler St Cif Omaha County:Douglas Zip Code:68116 Home Phone Number:402-614-2644 Business Phone Number:402-630-2421 Social Security Number: Drivers License Number&State: NE Date Of Birth. Place Of Birth:Council huffs, IA o [o to ❑YES ®NO ,�01-L--- -u ytYL`�,V,..L-��LF r Gam .+". rr.., Spouses Last Name: First Name: Mt: Social Security Number: Drivers License Number&State: Date Of Birth: Place Of Birth: ".:Mir; 17�� a'tl \ �E nl f�Ata� r�: • r - { 7 CITY&STATE YEAR YEAR CITY&STATE YEAR YEAR FROM TO FROM TO • Omaha, NE 2001 Present Fono 103 Rev 1/2011 Page 3ofS i mot. _ ., _ .... ..., .•.��.. >.... ...__✓.�.. ....> .. ,. �.. ... .. ., c3'. Name of Corporation/LLC: -OMAHA,INC. • "-.0 1 l a I f 0 1 ell}'�Y - a / r ; ' •.�,i'. �._ S ��n . �'c� $ i .� ` YE - 4y 1 !��r y> 1 Premise License Number: 'xc' ' (if new application leave blank) Premise Trade NameIDBA: OHOWHE PLAZA HOTEL Premise Street Address: 655 N. 108 Ave City. Omaha State: NE Zip Code:68154 Premise Phone Number:402488-0850 The individual whose name is listed as a corporate officer or managing member as reported on insert form 3a dior 3their name blow ..c..., .a/-(4. L...._ . CORPORATE OFFICER/MANAGING MEMBER SIGN TUBE (Faxed signatures are acceptable) Faun 103 Rav U2011 Page 2 of 5 1100004027 a stricted to sand volleyball,horseshoe pits...) 1 1 Ck -71 D -- 14S--Lib or\ Tc- -1 'ssK� .�`st.,.'�',*:.:� �~�, ..x..�s-^�s����: E.'s Jl '.� Ll:` •"iGt3L."'�4�'3ur��f^c9�a'�r- f`. '-x 4 sr?-a. . C�v.� YEAR NAME OF EMPLOYER NAME OF SUPERVIS 0 R TELEPHONE FROM TO NUMBER 2011 Present HMC Bob Holsten 214-912-8805 1986 2010 Carlson Hotels Sean Shanno 612-877-1816 .. A �JrIM1�i :y1'4171rQ ed 0 � J .i 'M4:�== ky- ° ; _6J n ' mnY- =1. READ CAREFULLY. ANSWER COMPLETELY AND ACCURA LV. Hasanyone who is a party to this application,or their spouse,,EVER been convicted of' plead guilty to any charge. Charge means any charge alleging a felony,misdemeanor,vio ; a, violation of a local law, ordinance or resolution. List the nature of the charge,where th- :_ .r �- ` and conviction or plea. Also list any charges pending at the time of this application. • - + .: one ••t ,p -; list charges by each individual's name. YES (] NO MAR 1 4 2011 MAR J', 2011 If yes,please explain below or attach a separate page. AIEY. * o1i?^ aged i8AM9Q Name of Applicant Date of NT*si 1i,>+,`+,• 4Ul1TR®L V �` Conviction Convi (mm/yyyy) (city&stale) • 2. Have you or your spouse ever been approved or made application for a li uor license in Nebraska or any other state? OYES ENO IF YES,list the name of the premise. 3. Do you,as a manager,qualify under Nebraska Liquor Control Act 053-1 c 1.01)and do you intend to supervise,in person,the management of the business? []YES ONO 4. Have you enclosed the required fingerprint cards and PROPER FEES I this application? Check or moneoorder made payable to the Nebraska State Patrol for 00 per person) IJYES O Form 103 Rev 1r2011 Pogo 4ofS sert form 3a dior 3their name blow ..c..., .a/-(4. L...._ . CORPORATE OFFICER/MANAGING MEMBER SIGN TUBE (Faxed signatures are acceptable) Faun 103 Rav U2011 Page 2 of 5 1100004027 a stricted to sand volleyball,horseshoe pits...) 1 1 Ck -71 D -- 14S--Lib or\ Tc- -1 G�ia�EO�� RECEIVED MAR 2 2011 MAR 1 4 2011• 7.'1� J ` . �r'^^^ '.' 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 statenients contained therein are ' e. If any false statement is made in any part of this application, the applicant(s) shall be deemed gui 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 ' ' • including all records of every kind and description including police records, tax records (State and F.=•eral), 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 •• er individual disclosing or releasing said information to the Nebraska Liquor Control Commission. If spo - 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 e information submitted in this application, is subject to cancellation if the information contained herein 'I. incomplete, inaccurate, or fraudu /VA-644;f, )7)q 40 r3& Signature of Manager Applicant Signature of'pouse • ACKNOWLEDGEMENT State of Nebraska County of T)p U,s Q S The foregoing instrument was: knowic dged before me this as li by i-e sa m Por er- date name of person adortmledged •%'') 11)4i NoPu c signature = GENERAL NOTARY-State of Nebraska Gi JANE McNAUGHT My Comm.Ebcp.April 14,2013 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. Farm 103 Rev 1/2011 PageSof5 ll,horseshoe pits...) 1 1 Ck -71 D -- 14S--Lib or\ Tc- -1 City of Omaha J\febrasl€g 1819 Farnam—Suite LC 1 flit trio td Omaha, Nebraska 68183-0112 0 ' `� Buster Brown (402) 444-5550 � =410 City Clerk FAX (402) 444-5263 s&i F 8O ��� April 5, 2011 LM-Omaha, Inc. Application to appoint Teresa Porter Dba"Crowne Plaza Hotel" manager of your present Class "C" 655 North 108th Avenue Liquor License location Omaha,NE 68154 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 April 19, 2011 . 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 and acknowledge that any license issued, based on e information submitted in this application, is subject to cancellation if the information contained herein 'I. incomplete, inaccurate, or fraudu /VA-644;f, )7)q 40 r3& Signature of Manager Applicant Signature of'pouse • ACKNOWLEDGEMENT State of Nebraska County of T)p U,s Q S The foregoing instrument was: knowic dged before me this as li by i-e sa m Por er- date name of person adortmledged •%'') 11)4i NoPu c signature = GENERAL NOTARY-State of Nebraska Gi JANE McNAUGHT My Comm.Ebcp.April 14,2013 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. Farm 103 Rev 1/2011 PageSof5 ll,horseshoe pits...) 1 1 Ck -71 D -- 14S--Lib or\ Tc- -1 oi„ City of Omaha, Nebraska :� xi = ��� 1/4 1819 Farnam—Suite LC 1 ® ;��'d _ Omaha, Nebraska 68183-0112 0 t `' Buster Brown (402) 444-5550 �� �• City Clerk FAX (402) 444-5263 04, FE�R9.t►�� April 5, 2011 Teresa Porter Application to be appointed manager of the present 15657 Sahler Street Class "C" Liquor License locations for LM-Omaha, Omaha,NE 68116 Inc., dba"Crowne Plaza Hotel", 655 N 108th Ave Dear Liquor Lic ense cense 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 April 19, 2011 . 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, ,ef‘ Buster Brown City Clerk • BJB:clj cancellation if the information contained herein 'I. incomplete, inaccurate, or fraudu /VA-644;f, )7)q 40 r3& Signature of Manager Applicant Signature of'pouse • ACKNOWLEDGEMENT State of Nebraska County of T)p U,s Q S The foregoing instrument was: knowic dged before me this as li by i-e sa m Por er- date name of person adortmledged •%'') 11)4i NoPu c signature = GENERAL NOTARY-State of Nebraska Gi JANE McNAUGHT My Comm.Ebcp.April 14,2013 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. Farm 103 Rev 1/2011 PageSof5 ll,horseshoe pits...) 1 1 Ck -71 D -- 14S--Lib or\ Tc- -1 A - -, a• • 0 cr efti O p SD C, 1-t ,..1 " \ oto cep 0 CI) CA n •9, v On cp CD R F td I K . c " _ � . ' n § @ o . . 4i11 9` q C p Ii - 4Il '4T w , \ . / c4 '- FR-rI' t 7. 0 ƒ k . x - @. t6 § 7 \ c m � ¥ o 0 N t \ 0600 *STKHLDR- MICHAEL KELLEY* CORP ADDRESS & PHONE-7134 PACIFIC STREET, 68106-397-1898 * ATTY MIKE KELLEY-397-1898