RES 2010-0620 - Appoint James L Etter manager of Spring Lake Golf Course .=o EKE sTarFo, (()) r t �.
�~ x `- • �� STATE OF NEBRASKA
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.., Dave Heineman , NEBRASKA LIQUOR CONTROL COMMISSION
�' T 0 c� Governor Y .l Hobert B. Rupe
Executive Director
1t p9RCH in 15r^ 301 Centennial Mall South,5th Floor
CIT Y c C R K P.O.Box 95046
C l Lincoln,Nebraska 68509-5046
O M A H A., N L 6 R A. . : Phone(402)471-2571
May 4, 2010 Fax(402)471-2814
TRS USER 800 833-7352(TTY)
web address:http://www.lcc.ne.gov/
OMAHA CITY CLERK
1819 FARNAM FC-1
OMAHA NE 68183
RE: City of Omaha Municipal Corp DBA Spring Lake Golf Course
LICENSE #A - 09634
Dear Clerk:
Enclosed is a copy of a manager application for James L Etter in connection with Spring Lake Golf
Course, located at 4020 Hoctor Boulevard in Omaha.
Please present this application for manager to your City/Village Council or County Commissioners and
send us the results of their action.
Sincer:
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Lymake
Licensing Division
NEBRASKA LIQUOR CONTROL COMMISSION
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Janice M.Wiebusch Bob Logsdon Robert Batt
Commissioner Chairman Commissoner
An Equal Opportunity/Affirmative Action Employer
Printed with soy ink on recyded paper
f Sp Z'RASKALIQUOR
a -OL COMMISSION
State of Nebraska
County of County of
The foregoing instrument was acknowledged before The foregoing instrument was acknowledged before
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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
NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER
FROM TO
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Form 3c V Page 2
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Signature of in 'vidual involved with application Printed nam of applying individual
(Spouse of i ividual listed above)
State of gebracir._4, .
County of 1)(niGi&S The foregoing instrument was acknowledged before me this
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1vi1 1 ZM 0 bynti & 0 Jean l CIAO I'►'Iax M Piet0C'1
date name of person acknowledged
errs M1,tkAEI"S6190ALNOTY.Sisoltidaska
VICTORIA,
ELCH
Notary Public signature Cassia. inns 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
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MANAGER APPLICATION office Use
• INSERT-FORM 3c . . RECEIVED
NEBRASKA LIQUOR CONTROL COMMISSION
301
PO BCENTEN O 9X ENIAL MALL SOUTH MAR 1 9 ?n(n
LINCOLN,NE 65509-5046
PHONE:(402)471-2571 NEBRASKA LIQUOR
FAX:(402)471-2814 CONTROL COMMISSION
websne:www.lcc.ne,rtov
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
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Premise License Number: AO D1 3 L(
(if new application leave blank)
Premise Trade Name/DBA: .5 f R I t3 C- LP KE GO LP C ln:2SE
Premise Street Address: O a-0 \Ab c..TO 2 R,I--V D
City: O M N A State: N E Zip Code: 6 D !0 l
Premise Phone Number: '40:a `I `-no 3 0 .
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CORPORATE OFFICER SIGNATURE
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Signature of in 'vidual involved with application Printed nam of applying individual
(Spouse of i ividual listed above)
State of gebracir._4, .
County of 1)(niGi&S The foregoing instrument was acknowledged before me this
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date name of person acknowledged
errs M1,tkAEI"S6190ALNOTY.Sisoltidaska
VICTORIA,
ELCH
Notary Public signature Cassia. inns 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
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Form 3c Page 2
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I. 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.
YES :No If yes,please explain below or attach a separate page.
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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.
DYES L�JNU
3. Do you,as a manager,have all the qualifications required to hold a Nebraska Liquor License? Nebraska
Liquor Control Act(§53-131.01)
DYES QNO
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)
NYEs "ONO Q� (11-e, 02010
5. List the training and/or experience(when and where)
Date: Where:
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Social Security Number: _ — - . -- , Drivers License Number&State: _ _._
Date Of Birth: Place Of Birth: O(mho_ k)(2.-
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Form 3c Page 2
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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.
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
Atilt,142eA_
ignature of Manager Applicant Signature of Spouse
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State of Nebraska
County of kd Q ` a ¶ County of 03 t C�S
The foregoing instrument was acknowledged before The foregoing instrument was acknowledged before
me this (\Aare)" , -20 \0by me this 1,11 C.rL,,\". 16, ZVi(/by
N Public signature Notary ublic signature
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BRUCE W.WRONA 1 ♦ ONE W.WflBNA
Affix s Here General Notary 1 Afiix seale
4 State of Nebraska r General Notary
My Commission Expires Nov 9,2013 f ( State of Nebraska
k My Commission Expires Nov 9,2013
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
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Form 3c Page 2
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Signature ofspouse for waiver Printed name of spouse asking far waiver
(Spouse of individual listed below)
Stale of .-71c1 kw _ .
County of r1 • The Seeping insowtnleat was acknowledged befbre ins this
. Matti `aw
atm of'Mtnsiu
Gamy Publte ligneous my Consommes/sobs*Nov A•2013
y, : i ) r , !: •' 3 '" 1. : v: . ' , ' ,•• : lr•y:'. •\r ;�.,' .k� . .., y«SL;' ,.:\: ; i. :•_ }..•,v.+ , ••; • �, ,, .wrir:, -fir ,t,.,� i( .� 4 Irl' it I;I:. r•q 1" - t '; I tt l`t I •. r n r ,.• a t6.I , , t t f c.oltbit..... Tot
S tare of individual involved ---•�•..__ .. ,..
(Spouse of individual tided ebova) � PtfrTled name of appllyingying
individual
state of_idz5j'terr
County , sires —., The foregoing intro sent was acknowledged Wive mu this
• triAg: _ems d2 'O — .bY.__d,+sr4 Cie. w rt)
Nano PAIIII Moist
Notary , s, o - .�'
INAMIN J.Imams 1
lam.
Asa dq w Fetid ugnad In 1s palm th Ammo rat leM.w rapists odd ANIMA,
IIQOM;$41/1
•
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CITY&STATE YEAR CITY&STATE YEAR
_
• FROM TO I .. _
FROM TO
,...
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YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER
FROM TO
lq 75
&.j 4,4yer 4i4w- 17(9'eloyo e J Ty o f C5 fro R-AA-
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Form 3c Page 2
�MAHA, N
City ofOmaha Webras&a : 111 '
Eiw�011� (;r`rt p
1819 arnam—Suite LC 1 z �'�
Omaha, Nebraska 68183-0112 0, err.•'
Buster Brown (402) 444-5550 .o �'
City Clerk FAX (402) 444-5263 OJ.? FEBRv,4�
May 11, 2010
Cityof Omaha, A Municipal Corporation Application to appoint James L. Etter
dba"Spring Lake Golf Course" manager of your.present On Sale Beer
4020 Hoctor Blvd License
Omaha, NE 68107
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 May 25, 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,
4.40
Buster Brown
City Clerk
BJB:clj
isted below)
Stale of .-71c1 kw _ .
County of r1 • The Seeping insowtnleat was acknowledged befbre ins this
. Matti `aw
atm of'Mtnsiu
Gamy Publte ligneous my Consommes/sobs*Nov A•2013
y, : i ) r , !: •' 3 '" 1. : v: . ' , ' ,•• : lr•y:'. •\r ;�.,' .k� . .., y«SL;' ,.:\: ; i. :•_ }..•,v.+ , ••; • �, ,, .wrir:, -fir ,t,.,� i( .� 4 Irl' it I;I:. r•q 1" - t '; I tt l`t I •. r n r ,.• a t6.I , , t t f c.oltbit..... Tot
S tare of individual involved ---•�•..__ .. ,..
(Spouse of individual tided ebova) � PtfrTled name of appllyingying
individual
state of_idz5j'terr
County , sires —., The foregoing intro sent was acknowledged Wive mu this
• triAg: _ems d2 'O — .bY.__d,+sr4 Cie. w rt)
Nano PAIIII Moist
Notary , s, o - .�'
INAMIN J.Imams 1
lam.
Asa dq w Fetid ugnad In 1s palm th Ammo rat leM.w rapists odd ANIMA,
IIQOM;$41/1
•
AIMhd 1001
,, .71;44„.'yt--1 ,„i* 6.4, , - ,,,•s'i=•';' 7,"fig.
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CITY&STATE YEAR CITY&STATE YEAR
_
• FROM TO I .. _
FROM TO
,...
/ V//6-- 2/4I/A-Ad e./Acit, ielq/ .2 0/41 /1//1.5" Z//1/.4-•••• C/k•C le /If/
0 AAA K.,.- A,c )2. O )41.+-11.0 /1,eifi •
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'''' '`, IR" ' ,!4•4444 4,' .0 t . 'tg" •,Q• 4 4. ‘1,14t,\ ,i'i ' C'er rwo ,,', , ,•,,n-)-$11, %.,),11:, l'• ''.74c,4W.I....•'''s '"- , ,`,
YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER
FROM TO
lq 75
&.j 4,4yer 4i4w- 17(9'eloyo e J Ty o f C5 fro R-AA-
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Form 3c Page 2
. oM,,H,, N
�OF ° FB.p
City o Omaha, fl'slebras&ac. 1 ' -°��
1819 Farnam— Suite1 z ilkMIritrtI/ 4. r,
)_C ti V�
Omaha, Nebraska 68183-Q112 0® xs.n'' •
Buster Brown (402) 444-5550 A el."
City Clerk FAX (402) 444-5263 O�'l'ED FEBl �44
May 11, 2010
James L. Etter Application to be appointed manager of the present
14415 Lillian Circle On Sale Beer License for City of Omaha, A Municipal
Omaha,NE 68138 Corporation, dba"Spring Lake Golf Course",4020
Hoctor 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 May 25.,
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,
�____
0 , 47 ,,,b'S";e'ae,— -.
Buster Brown
City Clerk
BJB:clj
. Matti `aw
atm of'Mtnsiu
Gamy Publte ligneous my Consommes/sobs*Nov A•2013
y, : i ) r , !: •' 3 '" 1. : v: . ' , ' ,•• : lr•y:'. •\r ;�.,' .k� . .., y«SL;' ,.:\: ; i. :•_ }..•,v.+ , ••; • �, ,, .wrir:, -fir ,t,.,� i( .� 4 Irl' it I;I:. r•q 1" - t '; I tt l`t I •. r n r ,.• a t6.I , , t t f c.oltbit..... Tot
S tare of individual involved ---•�•..__ .. ,..
(Spouse of individual tided ebova) � PtfrTled name of appllyingying
individual
state of_idz5j'terr
County , sires —., The foregoing intro sent was acknowledged Wive mu this
• triAg: _ems d2 'O — .bY.__d,+sr4 Cie. w rt)
Nano PAIIII Moist
Notary , s, o - .�'
INAMIN J.Imams 1
lam.
Asa dq w Fetid ugnad In 1s palm th Ammo rat leM.w rapists odd ANIMA,
IIQOM;$41/1
•
AIMhd 1001
,, .71;44„.'yt--1 ,„i* 6.4, , - ,,,•s'i=•';' 7,"fig.
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CITY&STATE YEAR CITY&STATE YEAR
_
• FROM TO I .. _
FROM TO
,...
/ V//6-- 2/4I/A-Ad e./Acit, ielq/ .2 0/41 /1//1.5" Z//1/.4-•••• C/k•C le /If/
0 AAA K.,.- A,c )2. O )41.+-11.0 /1,eifi •
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YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER
FROM TO
lq 75
&.j 4,4yer 4i4w- 17(9'eloyo e J Ty o f C5 fro R-AA-
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Form 3c Page 2
7
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