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RES 2010-0393 - Appoint Peter J Kolb manager of Upstream Brewing Company .1��,. ♦ �,47 t Y F C E STATE OF NEBRASKA rz ay a ,-,�;'J1x..c y i Dave Heineman 10 f' ,Pt R 6 i r; B .• NEBRASKA LIQUOR CONTROL COMMISSION �i4� , ;rr '' � Governor L t Hobert B. Rupe ii t\ 9R.::. • 86�_ Executive Director CLERK 301 Centennial Mall South,5th Floor CITY P.O. Box 95046 • 0 M A lH A. N t_B B A S \ Lincoln, Nebraska 68509-5046 Phone(402)471-2571 Fax(402)471-2814 March 12, 2 1� 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: UPSTREAM BREWING COMPANY LICENSE kEI— 3477 L - 34777 Dear Clerk: Enclosed is a copy of a manager application for Peter J Kolb in connection with Upstream Brewing Company, located at 514 S 11 Street 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, LynQL9 ake Licensing Division NEBRASKA LIQUOR CONTROL COMMISSION encl. cc: file Janice M.Wiebusch Bob Logsdon Robert Batt Commissioner Chairman Commissoner An Equal Opportunity/Affirmative Action Employer Printed with soy ink on recycled paper MANAGER APPLICATION Office Use INSERT}FORM 3c ( EPEI@N/Er' NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH RFC PO BOX 95046 MAR 0 8 2010 I LINCOLN,NE 68509-5046 PHONE:(402)471-2571 p� y FAX:(402)471-2814 i EBRASKA LIQUOR MAR 0 1 2010 webs+le:www.(cc.ne.Kov CONTROL COMMISSION Corporate manager,including spouse,are required to adhere to the following requirementspA a�fEBRA'SI(f1LIQUOR if spouse filed affidavit of non-participation fingerprints and proof of citizenship not required"NTROt COMMISSION 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 fingerprints(2 cards per person) 5) Must be 21 years of age or older 6) Applicant may be required to take a training course Name of Corporation/LLC: [ r( ,�,e(-(V1 EREi„9 In)(r TA-" ��/ f Premise License Number: 341--R-cs. ( o ) 343-79- tZegt...) ita,) leave bl ank) new application ea e bank) Premise Trade Name/DBA: UpS>r(ZG--41A 5 G—c..-2l Coviekekk.y 1 Premise Street Address: 5144 cS- (1 N= c t City: 6 IM1yk-4A-- Zip Code: { 3(o Z Premise Phone Number: (4cz) 31-i - OZoo F------- CORPORATE OFFICER SIGNATURE (Faxed.sit atures are acce stable I i ' 11, Ill i • 4 --- 1000004418 Form 3c Gender: MALE OIFEMALE Last Name: V.I,(.,Pj First Name: Pe e MI: _ Home Address (include PO Box if applicable): 1(0 - �_ 51 City: d, ,,l/k State: Ne- Zip Code: t9E2`() 1 Home Phone Number: (.h1oz) L t — gtd $ Business Phone Number: ( az) 34 OZI('j Social Security Number: ,, Drivers License Number&State: Pr _ Date Of Birth Place Of Birth: Doub( 3 , 135(30 YES ❑NO Spouses Last Name: V•,O(,() First Name: gY MI: 14, • Social Security Number: i _Drivers License Number& State: Date Of Birth Place Of Birth: Q v v - A4Allk t‘ "" • TTY&STATE YEAR CITY&STATE YEAR FROM TO FROM TO DMi tiA rJ6= tqctLa Zo 10__ OM/kt ik 13 E- la13-6z tO 1 D YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER FROM T T. l` CL I'�• (f CUtt3 'C .5 V(cv& - wig eispo."'`/ Form 3c Page 2 leave bl ank) new application ea e bank) Premise Trade Name/DBA: UpS>r(ZG--41A 5 G—c..-2l Coviekekk.y 1 Premise Street Address: 5144 cS- (1 N= c t City: 6 IM1yk-4A-- Zip Code: { 3(o Z Premise Phone Number: (4cz) 31-i - OZoo F------- CORPORATE OFFICER SIGNATURE (Faxed.sit atures are acce stable I i ' 11, Ill i • 4 --- 1000004418 Form 3c • 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. EYES yes,please explain below or attach a separate page. MAR 0 8 2010 � cA �°. - NEBRASKA-LIQUOR MAR 01201Z CONTROL COMMISSION 6 RAL KA LIQUOR OMM SSION CONTT RO 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. AYES ONO OpSaE/{-M 2" 1^)(a .PV`'‘f)A-1° / 3. Do you, as a manager,have all the qualifications required to hold a Nebraska Liquor License? Nebraska Liquor Control Act(§53-131.01) YES ENO 4. Have you filed the required fingerprint cards and PROPER FEES with this application? (The check or money e eutto the Nebraska State Patrol for-3it°° ";o'weia) .-s yt,Atfa, t �J YES .• tc.., ONO # 1rc�>a j,. ... , rra; r •yn ,.', 5. Do you have any experience in selling alcohol in the State of Nebraska? If so list training and/or experience(when and where) Date: Where: ID•a62 7 C -2F'AJf Opscel Ai-ar r i%4c' WI C COM elie9 Form 3c Page 3 The above ind ividual(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 in;hiding 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. Z.()CL1QC CC)e ig re of Manager Applicant Signature of�Spouse State of Neb:aska County of County of g...,16,..„ . , The foregoing instrument was acknowledged before „9X The foregoing instrument was acknowledged before me this /bii, "' 00a me this I(„tw � crl � by � K0�8 �. '� � by �`KH�t Y u 0 �0 Notary Pu lc signature Notary Public signature Affix Seal Here , ` Affix Seal Here TAMI LARKIN t GenerTAMIal LARKIN . I General Notary ''. I State of Nebraska ` State of Nebraska 4 My Commission Expires Dec 1,2013 ` i My Commission Expires Dec 1,2013. 0 • 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 , SPOUSAL AFFIDAVIT OF t Office use NON PARTICIPATION INSE , i ...,, NEBRASKA LIQUOR CONTROL COMMISSION MAR 201L� 301 CENTENNIAL MALL SOUTH MAR O$ 2010 PO BOX 95046 LINCOLN,NE 68509-5046 PHONE:(402)471-2571 111ESRASKA UQUO FAX:(402)471-2814 NIEBRASKA LIQUOR CONTROL �'�MMISSI®� Website: www.lcc.ne.gov CONTROL COMMISSION I.acknowledge t#I am the flf � . My � ► .'o ! e a thavey } interest,dunctly or. directly in l opa+ wfit of to buslnt 5 .(I3)�of TT� Act w ill. lot: tend 1� f�1�I�q�A�liq �r1�� p�Q y��,,c�> /,1 ,{� bar,maker r e tr nf"'rr � �!sign. o,K �J ..+4. as the wn o r 11,t / ��lly F � � ways.participateaain tli ytt da;< t }ne ,.taY;t_ . 1, t� . „ 1 t3 otbe l�aqu��ired,l e�I s.}n ,j yd tO3 ;, . ,, 11 ,i ., r .1. oDs V ,"Z ired, A • E�aFr�'R^'� r�il��S�i�KI , . r �` i<� �Je"' ` �Y`�b t�� } � �}�� „..„„.,�. : '�.: •4w S' ? r. ,.at '.s` .! y.4!.fit :1. .0- r;` "r. •41. i _,.: r , YS ) 'r >r t • 7JQkQ iS of spouse asking for waiver Printed name of spouse asking for waiver (Spouse of individual listed below) State of k1Fgpt5 County of V9uk-iliy3 The foregoing instrument was acknowledged before me this 162 4& OF ket2tA4LtZ, IQ by 1�R le- JL.oL4 / name of person acknowledged /'f /.-- • Affix Seal / 4 General Notary I Notary c signature state of Nebraska ` k My Commission Expires Dec 1.2013 i te o a 1 o a i ,P ', 1. 1 V `rs+E/ x q1 L�,� i n '' J�' l;` �'A 7 S 1' T5� f' riI „S. c ir'QEt•^el {? 5.a +a.l ".G i.r" y -�1 t [ CEO 1 i - g F - Vf Si:- o vidual involved with application Printed name of applying individual (Spo• e o dividual listed above) State of + County of t)5(Aks`( The foregoing instrument was acknowledged before me this I GAL 010,1. Ol 0 by Pam Koa datete� / name of person acknowledged ei — Affix Seal I ( �NotaryLARKIN Notary lic signature , State of Nebraska l My Commission Expires Dec 1,2013 • I — — - --�— -- In compliance with the ADA,this spousal affidavit of non participation is available in other foments for persona with disabiities. A ten day advance period is requested in writing to produce the alternate format. FORM 35-4178 Revised 1/2008 OMAHoi ‘,11 City of Omaha, Webras&a• W ,84p ,in �� 1819 Farnam —Suite LC1 z tikl '41 r, Omaha, Nebraska 68183-0112 0� Buster Brown (402) 444-5550 City Clerk FAX (402) 444-5263 O,p9TFD FEB " March 30, 2010 Upstream Brewing Company Application to appoint Peter J. Kolb 514 South 11th Street manager of your present Class "I & L" Omaha,NE 68102 Liquor Licenses 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 13, 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. Sincerelyyours, , Buster Brown City Clerk BJB:clj spouse asking for waiver (Spouse of individual listed below) State of k1Fgpt5 County of V9uk-iliy3 The foregoing instrument was acknowledged before me this 162 4& OF ket2tA4LtZ, IQ by 1�R le- JL.oL4 / name of person acknowledged /'f /.-- • Affix Seal / 4 General Notary I Notary c signature state of Nebraska ` k My Commission Expires Dec 1.2013 i te o a 1 o a i ,P ', 1. 1 V `rs+E/ x q1 L�,� i n '' J�' l;` �'A 7 S 1' T5� f' riI „S. c ir'QEt•^el {? 5.a +a.l ".G i.r" y -�1 t [ CEO 1 i - g F - Vf Si:- o vidual involved with application Printed name of applying individual (Spo• e o dividual listed above) State of + County of t)5(Aks`( The foregoing instrument was acknowledged before me this I GAL 010,1. Ol 0 by Pam Koa datete� / name of person acknowledged ei — Affix Seal I ( �NotaryLARKIN Notary lic signature , State of Nebraska l My Commission Expires Dec 1,2013 • I — — - --�— -- In compliance with the ADA,this spousal affidavit of non participation is available in other foments for persona with disabiities. A ten day advance period is requested in writing to produce the alternate format. FORM 35-4178 Revised 1/2008 HA, 4,4, Cityof I' �'� 1819 Farnam —Suite LC1 .. alirit%Plmi 6® ar Omaha, Nebraska 68183-0112 0 w•w _ Buster Brown (402) 444-5550 A _ ti' City Clerk FAX (402) 444-5263 O�44.D FEBW°s March 30, 2010 Peter J. Kolb Application to be appointed manager of the present 1617 North 59th Street Class "I &L" Liquor Licenses for Upstream Brewing Omaha,NE 68104 Company, 514 South 11th 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 April 13, 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, 44'"A°90 t Buster Brown City Clerk BJB:clj (Spouse of individual listed below) State of k1Fgpt5 County of V9uk-iliy3 The foregoing instrument was acknowledged before me this 162 4& OF ket2tA4LtZ, IQ by 1�R le- JL.oL4 / name of person acknowledged /'f /.-- • Affix Seal / 4 General Notary I Notary c signature state of Nebraska ` k My Commission Expires Dec 1.2013 i te o a 1 o a i ,P ', 1. 1 V `rs+E/ x q1 L�,� i n '' J�' l;` �'A 7 S 1' T5� f' riI „S. c ir'QEt•^el {? 5.a +a.l ".G i.r" y -�1 t [ CEO 1 i - g F - Vf Si:- o vidual involved with application Printed name of applying individual (Spo• e o dividual listed above) State of + County of t)5(Aks`( The foregoing instrument was acknowledged before me this I GAL 010,1. Ol 0 by Pam Koa datete� / name of person acknowledged ei — Affix Seal I ( �NotaryLARKIN Notary lic signature , State of Nebraska l My Commission Expires Dec 1,2013 • I — — - --�— -- In compliance with the ADA,this spousal affidavit of non participation is available in other foments for persona with disabiities. A ten day advance period is requested in writing to produce the alternate format. FORM 35-4178 Revised 1/2008 • • • > � � • ~ors t1 .fl5. N W 0 o v) w � C r• � _o o d CD LW O • (AD 0 CD rD oi EA CD l•