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RES 2011-1504 - Appoint Brian T Hill manager of Old Chicago ONE`S rq 1V (1147 _ �.; EC El STATE OF NEBRASKA W y- Dave Heineman NEBRASKA LIQUOR CONTROL COMMISSION Governor C 1 DEC -2 t'! 8: 03 Hobert B. Rupe 4r9R Executive Director t ,c\�cri 301 Centennial Mall South, 5th Floor P.O.Box 95046 CITY r L E P`K Lincoln,Nebraska 68509-5046 (�Pry A H!i, N L B R?.,C, Phone(402)471-2571 December 1, 2011 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: Old Chicago LICENSE #I-46465 Dear Clerk: Enclosed is a copy of a manager application for Brian T. Hill in connection with Old Chicago 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/Affirmatiue Action Employer Printed with soy ink on recycled paper denial of your application to the Nebraska Liquor Control Commission. Sincerely yours, Buster Brown City Clerk BJB:clj J.Russell Mothershed Vice President,Controller and Treasurer Kimberly Beasley Liquor License Specialist • Jennifer H.Hunt Liquor License Specialist • BE IT FURTHER RESOLVED, that the foregoing named individuals, together with;the names of any Area Directors, Regional Vice Presidents, group presidents and attorneys at law whose names are certified by the Secretary or Assistant Secretary to the requesting liquor control agency or commission;are hereby authorized and appointed to act as agent to make,execute,seal and deliver for and on behalf of the Corporation,and as its act and deed,for any of its premises operated under the tradenames,Ruby Tuesday,VAN Seafood Grill,Silver Spoon Cafe,Sweetpea s, and any other trade name owned,used or licensed by this Corporation from time to time,covering operations in any state of the United States of America,applications and'any related documents and any other papers required by the applicable liquor control agency and commission located In any state. BE IT FURTHER RESOLVED,that the Chief Executive Officer and the Secretary or any Assistant Secretary of the Corporation are authorized to execute a special power of attorney or any other documents which may be necessary to carry out the intent and purpose of these resolutions. BE iT FURTHER RESOLVED, that these resolutions are e Directors continuing then nature Codrporation. continue in full force and effect unless amended or rescinded by the B • BE IT FURTHER RESOLVED,'that the Chief Executive Officer, Secretary or A.4sistent Secretary of the Corporation be, and each hereby is, authorized and directed to attest any ch t� and the documentent or uvre required to effect the purposes of these resolutions and too affix the corporaa and th that approval and of any such officers shall be conclusive evidence of their authority from the Corporation ratification by the Corporation of the actions so taken BE IT FURTHER RESOLVED,that the Secretary or Assistant Secretary of the Corporation is hereby authorized estin :liquor control agencies and directed to provide and attest to resolutions provided or required by requ the corporate seal tite,rets ions for and on behalf of the Corporation as its act and deed and to authority from the and chat the and that the signature of any of such officers shall be conclusive en Corporation and the approval and ratification by the Corporation of the actions so tak t. • RECEIVED • • DEC 2 2011 • NEE'RA AKA LIQUOR CON';ROL COMMISSION RECEIVED DEC• 1 2011 MANAGER APPLICATION NEBRASKA LIQUidil INSERT-FORM 3c CONTROL COMMISSION NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH PO BOX 95046 N E 13 . ' ? i LINCOLN,NE 68509-5046 CONTROL ''..'1V 'S S I O( 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 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�sc MT; art 6a * rx r „: � � rr r5... { v (1 . Name of Corporation/LLC:Wadsworth Old Chicago, Inc. 4,, 41 "r. a �E .4 ' aY • � t `• Mii as:es.ra l , .» s ¢ 5 ' 4 _+a �� . . •/r . . k.k tit Premise License Number: (if new application eave blank) Premise Trade Name/DBA:OW Chicago Premise Street Address:13110 Birch Drive City:Omaha State:NE Zip Code:68164 Premise Phone Number:402-445-9393 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 Qom/ GORPQRATE OFFICER/MANAGING MEMBER SIGNATURE (Faxed signatures are acceptable) oa 111 /ME 11 0 0 0 11 0 f5 1100020111 1100019680 _. _ _ _ - — the requesting liquor control agency or commission;are hereby authorized and appointed to act as agent to make,execute,seal and deliver for and on behalf of the Corporation,and as its act and deed,for any of its premises operated under the tradenames,Ruby Tuesday,VAN Seafood Grill,Silver Spoon Cafe,Sweetpea s, and any other trade name owned,used or licensed by this Corporation from time to time,covering operations in any state of the United States of America,applications and'any related documents and any other papers required by the applicable liquor control agency and commission located In any state. BE IT FURTHER RESOLVED,that the Chief Executive Officer and the Secretary or any Assistant Secretary of the Corporation are authorized to execute a special power of attorney or any other documents which may be necessary to carry out the intent and purpose of these resolutions. BE iT FURTHER RESOLVED, that these resolutions are e Directors continuing then nature Codrporation. continue in full force and effect unless amended or rescinded by the B • BE IT FURTHER RESOLVED,'that the Chief Executive Officer, Secretary or A.4sistent Secretary of the Corporation be, and each hereby is, authorized and directed to attest any ch t� and the documentent or uvre required to effect the purposes of these resolutions and too affix the corporaa and th that approval and of any such officers shall be conclusive evidence of their authority from the Corporation ratification by the Corporation of the actions so taken BE IT FURTHER RESOLVED,that the Secretary or Assistant Secretary of the Corporation is hereby authorized estin :liquor control agencies and directed to provide and attest to resolutions provided or required by requ the corporate seal tite,rets ions for and on behalf of the Corporation as its act and deed and to authority from the and chat the and that the signature of any of such officers shall be conclusive en Corporation and the approval and ratification by the Corporation of the actions so tak t. • RECEIVED • • DEC 2 2011 • NEE'RA AKA LIQUOR CON';ROL COMMISSION 1 4,# '4..,.a.. aal:oy 0li}i116 ;k' 1 -'° yy .�� . ✓ - • � 'iM '.}. Gender: (MALE ❑ FEMALE Last Name: )4 t I( First Name: a >- t l�%C MI: Home Address(include PO Box if applicable): / C3cc 46t.,)t 1l .S-r City: OMc,hc, County: �oL 14 S Zip Code: 6d f2 Z Home Phone Number: 7O2-1 SO.701 7 Business Phone Number: Y42 'Ytt/S----. 3 /-3 ,, II Social Security Number: _ Drivers License Number&State: . ,Ne. Date Of Birth: Place Of Birth: O/Y164 7;/(_ K.♦- P1H'' '4 s, be ,..r-_ 4. 4 L -• 'y. * #B 14".♦ r: 4 io..f 1 YT.' H t • 4. y d �- va• c.. y�„ • 0 '^.'. : h _ "� w... ✓ yM.a.+.•.n.nirrjlAi�kW°\ * h ....�L k 'h' YES 0 NO } y1LL' •R Ja l n: ••t ,p. ..._t T ...a....M14 e: .J. -0.....--4 # .r --qr. - c ,.. =` Spouses Last Name: </ First Name: ii// MI: n Social Security Number: , Drivers License Number&State: , • _ Date Of Birth: _ _ Place Of Birth:��/' �r CITY &STATE YEAR YEAR CITY &STATE YEAR YEAR FROM TO FROM TO aIi c Ne6 , /ems .zvI RECEIVED RE(7:E1 EL'i DEC - 2011 ti, 't ) 4l1 NEBRASKA LIQUOR N.z. ,�.: .�fL (,:)R CONTROL COMMISSION CON"i I . C ;' .i tON Form 103 Rev l/2011 Page 3 of 5 eir name below C Qom/ GORPQRATE OFFICER/MANAGING MEMBER SIGNATURE (Faxed signatures are acceptable) oa 111 /ME 11 0 0 0 11 0 f5 1100020111 1100019680 _. _ _ _ - — the requesting liquor control agency or commission;are hereby authorized and appointed to act as agent to make,execute,seal and deliver for and on behalf of the Corporation,and as its act and deed,for any of its premises operated under the tradenames,Ruby Tuesday,VAN Seafood Grill,Silver Spoon Cafe,Sweetpea s, and any other trade name owned,used or licensed by this Corporation from time to time,covering operations in any state of the United States of America,applications and'any related documents and any other papers required by the applicable liquor control agency and commission located In any state. BE IT FURTHER RESOLVED,that the Chief Executive Officer and the Secretary or any Assistant Secretary of the Corporation are authorized to execute a special power of attorney or any other documents which may be necessary to carry out the intent and purpose of these resolutions. BE iT FURTHER RESOLVED, that these resolutions are e Directors continuing then nature Codrporation. continue in full force and effect unless amended or rescinded by the B • BE IT FURTHER RESOLVED,'that the Chief Executive Officer, Secretary or A.4sistent Secretary of the Corporation be, and each hereby is, authorized and directed to attest any ch t� and the documentent or uvre required to effect the purposes of these resolutions and too affix the corporaa and th that approval and of any such officers shall be conclusive evidence of their authority from the Corporation ratification by the Corporation of the actions so taken BE IT FURTHER RESOLVED,that the Secretary or Assistant Secretary of the Corporation is hereby authorized estin :liquor control agencies and directed to provide and attest to resolutions provided or required by requ the corporate seal tite,rets ions for and on behalf of the Corporation as its act and deed and to authority from the and chat the and that the signature of any of such officers shall be conclusive en Corporation and the approval and ratification by the Corporation of the actions so tak t. • RECEIVED • • DEC 2 2011 • NEE'RA AKA LIQUOR CON';ROL COMMISSION ...................................«...........,........._..._.«_.,...�.;,...•„.Jr:rl:�:::'r:::'::-n:��::�•:'a�:: ::::u.:.;:.,,,..,..-,.,.. ..........,..._,...�_.;. ..«._•':c nvw_.... ..w,. ,.,....... •..��.._:1' '.siammi::.h11Y .,n.., ,:,�..__..._.::: _ •: � � � ..::. �..� 1. ; � - �'..,t, :.,,..i;..:::..::!:'-r.;": :<: ;:Mt_:_, :: tiiy:.:�;:'sus_:� iay_,;'__�__.,n.;y I ;i}'a}4 „ ,, :�, « !. i; �. ..,,.._....«..t;::;;';:,r�.�::,:n:, 3n;�;:::a:r.:.-=.:G.. �.._"___....._:_...._ #1�� .r ��:� � '`«::K•::i1B�il� �!�''�.--.•n+.te,�!�HNc13L,�,�ral:!��i'".n:m n�,(��iTT1iL:. YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE FROM TO NUMBER 1 � (p %off Ss�r sz, <.�� Oki Gam• �n 7 -32. "Te� �, • .......................r ,...,.,,... ... ., .,...... .....,............ ._.....,................-.,-..,.....G,,,........................,..;,:......,_. .,:ri..,. *.• :ii EI:"' 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 any charges pending at the time of this application. If more than one party,please list charges by each individual' name. D 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 1 2011 NEBRASKA L1QUUC?R ,: T ` j, 2011 CONTROL COMMISSION 7... .. i 1i,*.•( :.?' • s .yam$ 2. . Have you or your spouse ever been approved or made application for a liquor license in Nebraska or - any other state? DYES gNO IF YES, list th e name of the premise. 3. Do you, as a manager, qualify under Nebraska Liquor Control Act(§53-131.01) and do you intend to supervise, in person,the management of the business? EYES ENO 4. Have you enclosed the required fingerprint cards and PROPER FEES with this application? (Check or money order made payable to the Nebraska State Patrol for$38.00 per person) OYES ONO Form 103 Rev 1/2011 Page 4 of 5 Assistant Secretary of the Corporation are authorized to execute a special power of attorney or any other documents which may be necessary to carry out the intent and purpose of these resolutions. BE iT FURTHER RESOLVED, that these resolutions are e Directors continuing then nature Codrporation. continue in full force and effect unless amended or rescinded by the B • BE IT FURTHER RESOLVED,'that the Chief Executive Officer, Secretary or A.4sistent Secretary of the Corporation be, and each hereby is, authorized and directed to attest any ch t� and the documentent or uvre required to effect the purposes of these resolutions and too affix the corporaa and th that approval and of any such officers shall be conclusive evidence of their authority from the Corporation ratification by the Corporation of the actions so taken BE IT FURTHER RESOLVED,that the Secretary or Assistant Secretary of the Corporation is hereby authorized estin :liquor control agencies and directed to provide and attest to resolutions provided or required by requ the corporate seal tite,rets ions for and on behalf of the Corporation as its act and deed and to authority from the and chat the and that the signature of any of such officers shall be conclusive en Corporation and the approval and ratification by the Corporation of the actions so tak t. • RECEIVED • • DEC 2 2011 • NEE'RA AKA LIQUOR CON';ROL COMMISSION RECEIVED • DEC I 2011 .»...,..,...x ..... .:...•,.x,. x,....,„�,xx:xn:u,..;:�ru:uu;»..u:.u,..,...: w .:. !., ... �1. .;. 1 a, t xf.•Mnx ra.. :t a',:. ,,`a 5 ,,,� }j g n frith,. 'T r": .. ,,,,:c•,:�!i.::::::73!f!11::=:.....:........_..;i:i�sll'=.l ! 'R. ..._�F• "':5i . w:!!1!!i�::Mnuas,::,irt:ir :CY�1C:C::xr.xi«!n� -� '��,... :��,��'! ..:F.."., �•5'•• �•L �" j •_.......__aill";:c}i=".;................: ::ecru}�?_,��,.,.,_,._.,r:_.,..__.. - -:--'_.,::-..:IN gl 4 .a is i:, a_..__.._srr.•. :;,._ie y —1,, , }.. .:.......,..___.•.•......_..�:..,..u!n::rx:•::o:y_5:-:nu••c..;.;;:•:-.n:c_d� �_:........� ..._......._ W:.••.I.r..a..,.e.,. .L�n u.l.d..c., i ` :::$•...::..�rru..........I!...,....u_. ,....__.....bE3..coar:r.:.J,......,...1'.L_:a.:au.....an:f:.::r-�.-.•.—=c•�.+ :.......:•::x.n.,..._.. _...._._., ._.:r.._< y r :.. i ' .riS_'�, F _...._._•5:::•n....z..:::r•n::::::-�-:_: •:::,n::a I:h.�.•_....._................:....r....•,...:..:•nn::>:::::n r.;.a;r;a...•..L�a:-:-::.a-:.,.......,:•,5::_:.:...«...,,....�.an:_... ,..n;;;ar.. • ::::r.-.•:.-ten„;.„_..;_.__:�• :u...._. �.....::__.,w......_.._._.......__......_,.�! •s�.•:na�:::w:.::�::.a:nr :•: :<.................!.:,.a_.�._:-::........_.._..a=a: .._:. .....L.,.... .:-_ _'___.. ::- .. !! .. :....::c!:ac:;,:.:..arc»:...»... •r.:M:::.a.::....::r:^».r:::.:..,.r.-:-:a:::r.!�:e,r.�::a:::::;_.p' ,I....:_�_v......1:1a:::a:{::::;:7:r�?:n:d::�":::t�,.,, q�. �(��'�',��y ., .. ... .� _.....,.. rn: A.i..1......__n.:,1.a.._.._..._... ...._..t_......=`.::::dr::':;r:InMc;�n:.:c:•c::r�:a::,::nl::::_:::I.........:::::.....r.,,c--,.;,,:».,.r.:..,r.:_..I..•.,,,.......u_,.,__.... ..a_...c3.rrn ,,i! �•• •i✓L q`p� �t 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. .."( • nt i Signature of Spouse ACKNOWLEDGEMENT State of Nebraska County of Dca.& (a.5 The foregoing instrument was acknowledged before me this lo/ 131 1 1 by 6(►0,te 1-11 ) ( and 31.) ( `- t date name of person acknowledged .71'. Affix Seal -..- ip dp.40, . -, '''- • Notary Public signature NICK,KLEIN. 00n rOl Notary 1 MOM o!tiiWaska 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 ,? w.�1 Rev 1/2011 �Yp_ F� 1, 2 Page5of5 CON tY•i'>1.. ',;g3h4 hit iS,3ION e of any of such officers shall be conclusive en Corporation and the approval and ratification by the Corporation of the actions so tak t. • RECEIVED • • DEC 2 2011 • NEE'RA AKA LIQUOR CON';ROL COMMISSION RECEWED rt Y SPOUSAL AFFIDAVIT OF Office Use NON PARTICIPATION INSERT i DEC I 2011 NEBRASKA LIQUOR CONTROL COMMISSION �r 301 CENTENNIAL MALL SOUTH NBRASKA LIQUOR PO BOX CONTROL COMMISSION ' ':: LINCOLN,NE NE 68509-5046 PHONE:(402)471-2571 i " FAX:(402)471-2814 j Website: www.lcc.ne.goy I 3*ae a• 9.c 1 !,17 a a,a a a r• i c p4c license;.holde>:�",�, low confirms .Twill have not have any ,E - . .c' n n �n .s.- " , i t:: , _S �;., liki,`.••i..; ,tea` a+^•e r, t of the;b l3 of the•' r Control Act. I will not i x . ,, ;xi . ..,.. t �1 )) Li t' to ;1` , ' 6 r,�r'" t�� ex , s,write,chec'ks ; ,represent myselfas:the owner or in any '' " , is ` +1 �a a ., u�5' �':' s Ybucine s any -y " understand my tgerprint will not.be S p i 'fie..F.. h.Pl a m' +: �^ - r et. • Kiy;r.5.�tr OJ9 ,ki;(w` 4 ., .^y,A.P y��.3y:L w : x l�lE(a�e �!f !a o`j,e 33a,.'h,� � g a� aR a av - �o3'�y�1�� ,.. �TCittIo115":I(Cf1.C��tO process this .4' 4 a. a L2 ' x a••:••::.;: ,. ...r b.'........4.S4' a.�.'w •%:'.' .r44..'J';A "JIB , a"..:: •. •:•.Y, .. .. itr , , t1 'M �� II of spouse asking for waiv r Printed name of spouse asking for waiver f-individual listed below) 1 State of `_ 1 County of_ e,.11 a S The foregoing instrument was acknowledged before me this 1 n v) t.vr•. r 1() 0 1 1 by -•�.% 11 '0 i " date ' name of person acknowledged / . i' Affix Seal Notary Public signature ilsorifilitirt 1 Sal ot gloom Mr cee+n ktien tons tOc 'II,20/8 " '" '` nsible for 7 q e hstecl�In '�P OVr 9® Z tand'that Itk sii *and I are reslso rg,,, 4 a ,.A,�y 3, s axsrs'�a4„rd''$ �'"•7 'r• 4 449 �'e`Ifit us, „t iat the above ilndividual has violated`(g53-125(l3))the Q Signature of in 1 application Printed name of applying individual (Spouse of individual listed above) \t State of V 4' \p c��c.l,.r County of -- 0 t,,�\4,SI The foregoing instrument was acknowledged before me this l`l. �j.1 e_rr - J(� ,.D a l I by Cal\f`x ra„-T -' , 1 /� date name of person acknowledged 1 ,/ Affix Seal I C011N1E S..'BALES t Notary Public signature i iqkattMtatMI-., i. i ..iti,calairwea0,p0so0ti,tota ,:I In compliance with the ADA,this spousal affidavit of n participation is available in other formats for persons with disabilities. A ten day advance period is requested in writing to cc the alternate format. FORM 35-4178 Revised 1/2008 s application, is subject to cancellation if the information contained herein is incomplete, inaccurate, or fraudulent. .."( • nt i Signature of Spouse ACKNOWLEDGEMENT State of Nebraska County of Dca.& (a.5 The foregoing instrument was acknowledged before me this lo/ 131 1 1 by 6(►0,te 1-11 ) ( and 31.) ( `- t date name of person acknowledged .71'. Affix Seal -..- ip dp.40, . -, '''- • Notary Public signature NICK,KLEIN. 00n rOl Notary 1 MOM o!tiiWaska 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 ,? w.�1 Rev 1/2011 �Yp_ F� 1, 2 Page5of5 CON tY•i'>1.. ',;g3h4 hit iS,3ION e of any of such officers shall be conclusive en Corporation and the approval and ratification by the Corporation of the actions so tak t. • RECEIVED • • DEC 2 2011 • NEE'RA AKA LIQUOR CON';ROL COMMISSION - Ov.AHA, 1y,, City ofOmaha, Webras&a 1/- 4,, mritr1819 Farnam Suite LC 1 ft yid Omaha, Nebraska 68183-0112 0 : �' Buster Brown (402) 444-5550 City Clerk FAX (402) 444-5263 047.Eo FEB10►i`4 December 6, 2011 Wadsworth Old Chicago, Inc. Application to appoint Brian T. Hill Dba"Old Chicago" manager of your present Class "I" 13110 Birch Drive Liquor License location Omaha,NE 68164 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 December 20, 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, 4t‘4/ Buster Brown City Clerk . BJB:clj se asking for waiver f-individual listed below) 1 State of `_ 1 County of_ e,.11 a S The foregoing instrument was acknowledged before me this 1 n v) t.vr•. r 1() 0 1 1 by -•�.% 11 '0 i " date ' name of person acknowledged / . i' Affix Seal Notary Public signature ilsorifilitirt 1 Sal ot gloom Mr cee+n ktien tons tOc 'II,20/8 " '" '` nsible for 7 q e hstecl�In '�P OVr 9® Z tand'that Itk sii *and I are reslso rg,,, 4 a ,.A,�y 3, s axsrs'�a4„rd''$ �'"•7 'r• 4 449 �'e`Ifit us, „t iat the above ilndividual has violated`(g53-125(l3))the Q Signature of in 1 application Printed name of applying individual (Spouse of individual listed above) \t State of V 4' \p c��c.l,.r County of -- 0 t,,�\4,SI The foregoing instrument was acknowledged before me this l`l. �j.1 e_rr - J(� ,.D a l I by Cal\f`x ra„-T -' , 1 /� date name of person acknowledged 1 ,/ Affix Seal I C011N1E S..'BALES t Notary Public signature i iqkattMtatMI-., i. i ..iti,calairwea0,p0so0ti,tota ,:I In compliance with the ADA,this spousal affidavit of n participation is available in other formats for persons with disabilities. A ten day advance period is requested in writing to cc the alternate format. FORM 35-4178 Revised 1/2008 s application, is subject to cancellation if the information contained herein is incomplete, inaccurate, or fraudulent. .."( • nt i Signature of Spouse ACKNOWLEDGEMENT State of Nebraska County of Dca.& (a.5 The foregoing instrument was acknowledged before me this lo/ 131 1 1 by 6(►0,te 1-11 ) ( and 31.) ( `- t date name of person acknowledged .71'. Affix Seal -..- ip dp.40, . -, '''- • Notary Public signature NICK,KLEIN. 00n rOl Notary 1 MOM o!tiiWaska 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 ,? w.�1 Rev 1/2011 �Yp_ F� 1, 2 Page5of5 CON tY•i'>1.. ',;g3h4 hit iS,3ION e of any of such officers shall be conclusive en Corporation and the approval and ratification by the Corporation of the actions so tak t. • RECEIVED • • DEC 2 2011 • NEE'RA AKA LIQUOR CON';ROL COMMISSION 0 h3_,A' 1V�8 City ® Omaha Ne bras a • `� �` ' �cPt lo r, 1819 Farnam—Suite LC 1 2 dv. Dirl i� ajr- Omaha Nebraska 68183-0112 0 .._ ^,' Buster Brown (402) 444-5550 City Clerk FAX (402) 444-5263 047' - ut►`k December 6, 2011 Brian T. Hill Application to be appoint manager of the Class "I" 7905 Howell Street Liquor License location for Wadworths Old Omaha,NE 68122 Chicago, Inc., dba"Old Chicago", 13110 Birch Dr. 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 December 20, 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 tate of `_ 1 County of_ e,.11 a S The foregoing instrument was acknowledged before me this 1 n v) t.vr•. r 1() 0 1 1 by -•�.% 11 '0 i " date ' name of person acknowledged / . i' Affix Seal Notary Public signature ilsorifilitirt 1 Sal ot gloom Mr cee+n ktien tons tOc 'II,20/8 " '" '` nsible for 7 q e hstecl�In '�P OVr 9® Z tand'that Itk sii *and I are reslso rg,,, 4 a ,.A,�y 3, s axsrs'�a4„rd''$ �'"•7 'r• 4 449 �'e`Ifit us, „t iat the above ilndividual has violated`(g53-125(l3))the Q Signature of in 1 application Printed name of applying individual (Spouse of individual listed above) \t State of V 4' \p c��c.l,.r County of -- 0 t,,�\4,SI The foregoing instrument was acknowledged before me this l`l. �j.1 e_rr - J(� ,.D a l I by Cal\f`x ra„-T -' , 1 /� date name of person acknowledged 1 ,/ Affix Seal I C011N1E S..'BALES t Notary Public signature i iqkattMtatMI-., i. i ..iti,calairwea0,p0so0ti,tota ,:I In compliance with the ADA,this spousal affidavit of n participation is available in other formats for persons with disabilities. A ten day advance period is requested in writing to cc the alternate format. FORM 35-4178 Revised 1/2008 s application, is subject to cancellation if the information contained herein is incomplete, inaccurate, or fraudulent. .."( • nt i Signature of Spouse ACKNOWLEDGEMENT State of Nebraska County of Dca.& (a.5 The foregoing instrument was acknowledged before me this lo/ 131 1 1 by 6(►0,te 1-11 ) ( and 31.) ( `- t date name of person acknowledged .71'. Affix Seal -..- ip dp.40, . -, '''- • Notary Public signature NICK,KLEIN. 00n rOl Notary 1 MOM o!tiiWaska 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 ,? w.�1 Rev 1/2011 �Yp_ F� 1, 2 Page5of5 CON tY•i'>1.. ',;g3h4 hit iS,3ION e of any of such officers shall be conclusive en Corporation and the approval and ratification by the Corporation of the actions so tak t. • RECEIVED • • DEC 2 2011 • NEE'RA AKA LIQUOR CON';ROL COMMISSION h a • t. a'dro � N 5 O,o.q":=..tr,,,c,,ei)(,.,,,z.,Sv O N — cmD a. O O . cpt:) 40,6cDi.. .CDD ¢ l�7 J Nzi N O -4 O n to O n W 0 ` NO0 -` � � � Q- i ,, C 0 ' ,\