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RES 2010-1267 - Appoint James Longcor manager of Super Saver #20 STATE OF NEBRASKA Dave Heineman R E C. L 1 V E NBRASKA LIQUOR CONTROL COMMISSION Governor Hobert B. Rupe Executive Director 301 Centennial Mall South, 5th Floor OCT -6 fir` `r P.O. Box 95046 Lincoln, Nebraska 68509-5046 CITY C!_r i;K Phone(402)471-2571 Fax(402)471-2814 OMAHA, N t B R A S K L TRS USER 800 833-7252(TTY) October 4, 2010 OMAHA CITY CLERK 1819 FARNAM STREET OMAHA NE 68183 RE: MANAGER APPLICATION License: #C-76794 Dear Clerk: Enclosed is a copy of a manager application for James Longcor in connection with Super Saver 20, 5710 S 144 Street. Please present this application for manager to your City Council and send us the results of their action. Sincerely, NEBRASKA LIQU ONTROL COMMISSION ndy Seybert Licensing Division rs encl. cc: •file • lank Wiebusch Bob Logsdon Bob Batt Commissioner Chairman Commissioner An Equal Opportunity/Affirmative Action Employer 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 . . . _ . ... .....• . ......„ . . . . . . . . • . . . ...... . . • •...... ••.•......•_ .. • .. . . .... ... .. �� L . ative Action Employer Printed with soy ink on recycled paper 1 i MANAGER APPLICATION Office use INSERT-FORM 3c NEBRASKA LIQUOR CONTROL COMMISSION rii tRECSIVOr) ) 301 CENTENNIAL MALL SOUTH PO BOX 95046 LINCOLN,NE 68509-5046 SEP 2 9 2010 PHONE:(402)471-2571 FAX:(402)471-2814 website:www.lcc.ne.aov NEBRASKA LIQUOR CONTROL COMMUNION Corporate manager,including spouse,are required to adhere to the following requirements If spouse filed affidavit of non-participation fingerprints and proof of citizenship not required 1) Must be a citizen of the United States 2) Must be a Nebraska resident(Chapter 2—006) 3) Must provide a copy of birth certificate,naturalization paper or US passport 4) Must submit their fingerprints(2 cards per person) 5) Must be 21 years of age or older 6) Applicant may be required to take a training course Corporation/Llmited Liability Corporation(LLC) information --- Name of Corporation/LLC: -804-t'"1 S Q,76 1 t Y�C. C`� .1.�-s n,,,� Premise information _ _ _�_ __ � Premise License Number: I LDl q 4 (if new application leave blank) Premise Trade Name/DBA: S L.pc_r CE)C .JCf' 4-2.0 Premise Street Address: ei 1() S , - ,i-r-e.c.:1' _ City: c Y10110. State: OZ.: Zip Code: Litt 1 Premise Phone Number: 140E— 7- Lolo 1 The individual whose name is listed to they resident or contac _rnembcr category on either insert form 3a or 3b ,. , :must sign their name below. � ,.. � ,. :,. - i 4,,Ni, 8 4 , i ,-41,4•1•71,4 ..) CORPORATE OFFI R SI NATURE Faxed signatures are accep`-L' 11111111111 Form 3c ' 1000019546 Egel I „,J • RECEIVED q4andger's.i.ntbniuitioillust be 04-..tinpl ,.' tielow', PLEASE PRITO CLEARLY , .: - • -- ''''rry' :,t, 44`1 1,q-1,,,--4...7' , 1_14.11tir • - ' • :, `"--'7 . 41,1,.aff -*k.'5`. 1,;,,,,....,, . r 4 sEp 2 9,2,01t2L1=AJ Gender: gs-MALE —1:1 FEMALE NEBRASKA LIQUOR patI Last Name: 1-01-19 c.or First Name:-Ta CONTROL COMIS rineS Home Address(include PO Box if applicable):5q CF.-) N VI 11-04'‘ Cli4. City: I—Ur\G oUn State: k.)G”. Zip Code: k.PC41-/ Home Phone Number: 31ci -3,2i- :3-4-1? Business Phone Number: 140/.. eft5 k_d_ott • - Social Security Number: _ — - - - - Drivers License Number&State. _ _ _ _ _ Date Of Birth: _ . _ . Place Of Birth: OSV-akCI S-OVMO [Arc you marritd?If yes4 complete.spotiq's Vformatioti(Even Xiktipousal tittikit bag becursubinitted,.) " . '•-,-- ' i., I - .,._. .. DYES [gi NO Spouse'i ihforMation „' -.0,- i''' ' 14+" , . . t41 ''•-.4-4 t+' t .3t •.• -• '. ''''':'•/4:: ''1,, • , N' i , 1 ' . .' -...i.t Spouses Last Name: First Name: MI: Social Security Number: Drivers License Number&State: Date Of Birth: Place Of Birth: APPLic—AT A141)/SPOUSE MUST 1.15,11410FogNcE(s)P )Jnix PAST ,APOLICANt ,, - SPOUSE • ,'... 4, , -. ".t. • ., 1 'it t` Ze CITY&STATE YEAR CITY&STATE YEAR FROM TO FROM TO 2 PlyrnmAttr. Marion b%5z3b2 1401 V 2,004 2.T/ii RoicpAtul tor t-tar c" IA 6230Z.24 2co4 SicZeTsibur 4 exturi So-14dd ILutpt lzblo 2ccR 546 twa pots GI- Luncatn +1E(siSt IIDCPI pros-enkt riiirTWO iYE" 4}^.RS'" - ' °,,..,',.. ,.. t- YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER FROM TO 10101 610q t•Itc..rnann Cczcd arn C-Dit V-112-51/13-rigga 101 cfg pew* 3k-12\SVorc9, k rsc. "Tam Se.v1 ui lc 1--4o2_-Limo-tAtO A-0 ' 1:::';1: 721, • Form 3c Page 2 • V rake ""y utz'�s; � � "�,,���,«�, 'yyfp� a �: : 7, �' � a� j`r"r'��4. ,if-spo ` 7 , few � �`�' 4; 1 £#i:1.—. 0,,,, t" .s� '#' • ;. 1,-1 ,7, P i�. PLEA P LE'� ♦W s t .AArx't >1: a, ,i , �dsri& a 4 ` x +... �' t 1 s.', 4�+,a k *Tv*^,� gat a yr s _ a.v , 1. '� • 1. READ PARAGRAPH CAREFULLY AND 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's name. OYES ©NO If yes,please explain below or attach a separate page. 2. Have you or your spouse ever been approved or made application for a liquor license in Nebraska or any other state? IF YES, list the name of the premise. EYES []NO I ,ne.-r 51ier b 7e. 1`kfl 3. Do you, as a manager,have all the qualifications required to hold a Nebraska Liquor License? Nebraska Liquor Control Act(§53-131.01) `2I YES ONO 4. Have you filed the required fingerprint cards and PROPER FEES with this application?(The check or money order must be made out to the Nebraska State Patrol for$38.00 per person) OYES ®NO flak- ne.Cer-aSarck - (` \t-uCl VS Co-�S T► .e_cl LOCI:1 5. List the training and/or experience(when and where) Date: Where: 2010 Poop-Am-rot ble. Aoo C.okhrci£ LcnCDU1 1JG Form 3c Page 3 riiirTWO iYE" 4}^.RS'" - ' °,,..,',.. ,.. t- YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER FROM TO 10101 610q t•Itc..rnann Cczcd arn C-Dit V-112-51/13-rigga 101 cfg pew* 3k-12\SVorc9, k rsc. "Tam Se.v1 ui lc 1--4o2_-Limo-tAtO A-0 ' 1:::';1: 721, • Form 3c Page 2 • 7-17 77, tt S �5� 7 F� 1 00 414, A � 9 �` �� � F S" a� _ �, �., A�Tgiiind°"'i- The above individuals being first duly swornupondeposes and states that the undersigned is the applicant and/or spouse individual(s), gY oath, � � PP P 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. 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 o ager pplicant Signature of Spouse S f Nebraska County of County of The foregoing instrument was acknowledged before The foregoing instrument was acknowledged before �l aJ O me this f/ by me this by 6?ittuti,z,_,e. Notary Public s' ature Notary Public signature Affix Seal Affix Seal Here GENERAL NOTARY•Stats of Nebraska, MARCENE E.GARDNER _.2. Pip Comm.Exp.Oct 18,2011 In compliance with the ADA,this manager insert form 3c is available in other formats for persons with disabilities. A ten day advance period is required in writing to produce the alternate format. • Revised 9/2008 Form 3c ____ Page 4 01 cfg pew* 3k-12\SVorc9, k rsc. "Tam Se.v1 ui lc 1--4o2_-Limo-tAtO A-0 ' 1:::';1: 721, • Form 3c Page 2 • °MAHA, �F • City of Omaha, fAlebraskg •��° 1 — "z tN��, Cn, n 18 9 Farnam Suite LC 1 r Omaha, Nebraska 68183-0112 0 �'.�; '- Buster Brown (402) 444-5550 06 City Clerk FAX (402) 444-5263 oR,.1 FEBR�t.i• October 19, 2010 B &R Stores, Inc. Application to appoint James Longcor Dba "Super Saver#20" manager of your present Class "C" Liquor 5710 South l44`" Street License location Omaha, NE 68137 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 2, 2010 . 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 f Nebraska County of County of The foregoing instrument was acknowledged before The foregoing instrument was acknowledged before �l aJ O me this f/ by me this by 6?ittuti,z,_,e. Notary Public s' ature Notary Public signature Affix Seal Affix Seal Here GENERAL NOTARY•Stats of Nebraska, MARCENE E.GARDNER _.2. Pip Comm.Exp.Oct 18,2011 In compliance with the ADA,this manager insert form 3c is available in other formats for persons with disabilities. A ten day advance period is required in writing to produce the alternate format. • Revised 9/2008 Form 3c ____ Page 4 01 cfg pew* 3k-12\SVorc9, k rsc. "Tam Se.v1 ui lc 1--4o2_-Limo-tAtO A-0 ' 1:::';1: 721, • Form 3c Page 2 • h, oi City ofOmaha, SAle bras a is-,,....,-,-,,,. `1 I's- sp atirift%G " L'e., n1819 Farnam —Suite LC 1• z i Omaha, Nebraska 68183-0112 0� j Buster Brown (402) 444-5550 4,o 1'' City Clerk FAX (402) 444-5263 SZ 1.7 U FE BR��.* October 19, 2010 James Longcor Application to be appointed manager of the present 5905 NW 14th Court Class "C"Liquor License for B &R Stores, Inc., Lincoln,NE 68521 dba"Super Saver#20", 5710 South 144th 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 2, 2010 . 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, d.4(,: " i? -I'�`` �fi e-�`'' ®� Buster Brown City Clerk BJB:clj knowledged before The foregoing instrument was acknowledged before �l aJ O me this f/ by me this by 6?ittuti,z,_,e. Notary Public s' ature Notary Public signature Affix Seal Affix Seal Here GENERAL NOTARY•Stats of Nebraska, MARCENE E.GARDNER _.2. Pip Comm.Exp.Oct 18,2011 In compliance with the ADA,this manager insert form 3c is available in other formats for persons with disabilities. A ten day advance period is required in writing to produce the alternate format. • Revised 9/2008 Form 3c ____ Page 4 01 cfg pew* 3k-12\SVorc9, k rsc. "Tam Se.v1 ui lc 1--4o2_-Limo-tAtO A-0 ' 1:::';1: 721, • Form 3c Page 2 • ° gin oCD CD N cA0oR° E CD a. C O 3 `" v1 " to r; ;�. Nn � 8 v'• CD ~ C q O 2. o UQ n N O N 0 C® O w "CD C7 " - N W 77' O `t can' ,Ot CD n O N cc cp 5 O 4. CD 0 p / @ 2 .0n G p 9 K ? 7 0 % N RTH * LICENSED PREMISES 1 STY BLDG 79'X 70'; EXCLUDING BASEMENT OFFICERS: OWNERIMGR-CARMELA BARRERA, 8414 SO 25TH AVE, BELLEVUE 68147 (C) 871-8323 * CORP ADDRESS & PHONE-7639 WRIGHT STREET, 68124#934-6600