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RES 2010-0394 - Appoint Peter J Kolb manager of Upstream Brewing Company • 1ri_ 4 � E'. ,.T ,1j1'1 L 17: i r ti 1 Y I'.yy \3,4 [ 1 1.— LJ 0 _ 1; �y STATE OF NEBRASKA i wFrO" 'ti% t. _ NEBRASKA y ct r;i�'� 3� 1 Gav, Dave Heineman 1 0 ; r .y ` 'v t.'+,;'. LIQUOR CONTROL COMMISSION !. rihrs . i •:�.; � Governor ..- Hobert B. Rupe VNv,4,A i^�s6 = Executive Director `, ,._ 301 Centennial Mall South,5th Floor P.CITY CL.'�^'K Box 95046 rr. ).;r, N B R°. H1 A Lincoln, NebraskaO68509-5046 Phone(402)471-2571 March 12, 2010 Fax(402)471-2814 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 #I— 34776; 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, • !r {i 7 !: r • LynnS i9 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 al 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 MANAGER APPLICATION Office Usc INSERT -FORM 3c 1vF, NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH J nrn 1 t1f7 �•: PO BOX 95046 MAR 0 8 2010 ,_•, LINCOLN,NE 68509-5046 PHONE:(402)471-2571 MAR(402)471-2814 NEBRASKA LIQUOR MAR 0 1 2010 Website:www.icc.ne.kov CONTROL COMMISSION Corporate manager,including spouse,are required to adhere to the following requirement��`(NEB�S�LIQUOF If spouse filed affidavit of non-participation fingerprints and proof of citizenship not required' QE 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: Op5tee-,�M �F,,9ln)41 '(y►�,/k,� LLC _T Y Premise License Number: 3`4.Th ( o ) (8eist,) R)..127 t n leave -/(tf new appl application Premise Trade Name/DBA: upst e ex;wroy Premise Street Address: 51L( S• (l 1-S , • City: 61MA-4A-- Zip Code: LcIa(07_ Premise Phone Number: (4cz) 344 - OZoo PiA4A1 L}-G Mh ti( ___. CORPORATE OFFICER SIGNATURE (Faxed si! atures are acce stable 1 0 ••r .t a-• I I 1 1000004418 Form 3c Robert Batt Commissioner Chairman Commissoner An Equal Opportunity/Affirmative Action Employer Printed with soy ink on recycled paper al 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 fit.. a:..,., 4`.,M_c-. rCt_ .... .. .. •• W k. ..-_ `:-- Yl- ` _:.- "--, t ..ems .. .. i.. ... Gender: [MALE El FEMALE Last Name: LvC,I- First Name: pe;te42._ MI: _ Home Address (include PO Box if applicable): aD t 7 0_ 5q ti. City: bev\-,th, State: j3e- Zip Code: LQj oil 1 Home Phone Number: ( 1oi) (ptL — LAO $ Business Phone Number: (uLoz) 344 _QZo17 Social Security Number: Drivers License Number& State: Or — Date Of Birth, Place Of Birth: Dada(,O3 eij. � c G'J /12YES ❑NO - Spouses Last Name: j(,() First Name: A-0-{Et— MI: (L.. . Social Security Number: _Drivers License Number& State: - __ Date Of Birth: _ -,--, Place Of Birth: QilAkLi k. 3 ; O �- , a 9" BI I, 39 'i 3i. CITY&STATE YEAR CITY&STATE YEAR FROM TO FROM TO WA' i 0C (4:1Ca tow O ornA k IJ F ten-Le Z I.c ?r YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER FROM TO Rib i etCair 0IT4 r .STF Ur(IX Wig t^^Phi1/4'`/ . ._.-. vy". -s ..-- Form 3c Page 2 .t a-• I I 1 1000004418 Form 3c Robert Batt Commissioner Chairman Commissoner An Equal Opportunity/Affirmative Action Employer Printed with soy ink on recycled paper al 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 ..� �.r* * �,, 'F 1q ' ti t S x - °• t'.l 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 -•� 0 yes,please explain below or attach a separate page. IVEr r. MAR 0 8 2010 pr NEBRASKA-LIQUOR CONTROL COMMISSION y�BBRASKA LIQUOR CONTROL COMMQIUSC ON 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. YES ENO ('piiLE4-frk '-(A ( ePtivymuy 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 `,, de eut`to the Nebraska State Patrol f �311°° '-p.'46%) 'LSJ r ES • «., ENO e42ti' ,S 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: (f)•q(iz 7 C 2 rOr- [)pSIV.RhAA/44•1.,/ ea, • lib r nL 01 4 it E C L'C1�1.E) Form 3c Page 3 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 . 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 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. • ,ej......Z. • . 9 CC-0ig a re of Manager ApplicantSignature oouse 1 State of Nebraska . ' County of County of g.,,,,,..64_, • The foregoir g instrument was acknowledged before sk The foregoing instrument was acknowledged before me this !(, t►t by �� me this IGaG� c ) by lCN X n� �I �D Notary Pu lc signature Notary Public signature Affix Seal Here Affix Seal Here I TAM!LARKINTAMI LARKIN 1 General Notary i State of Nebraska State of Nebraska I —My Commission Expires Dec 1,2013Dec ' --4....-Asp-----�� --.11 • 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 _____ - . r. .. Form 3c Page 4 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 SPOUSAL AFFIDAVIT OF ,' Office Use I � [ , NON PARTICIPATION SE C t rj, l NEBRASKA LIQUOR CONTROL COMMISSION �A� �Q�[� 301 CENTENNIALMALLSOUTH MAR 0 8 2010 !. PO BOX 95046• LINCOLN,NE 68509-5046 PHONE:(402)471-2571 NEBRASKA n.� U® FAX:(402)ww.lcc 471-2814 NEBRASKA LIQUOR CONT�3t�t.COMMISSI®011 Website: www.lcc.ne.eov CONTROL COMMISSION I acknawledgo t I am tl}e use of a x ; life r. My se w co s th t I w il:Mvea of#lave any interest,directly or'.lndirectiy in the'sieti i hoot bulsln (I3)):of the Uquor t�Act I will.not tend bar,soaks s,i rve pat'' is. V, ,, #heck,si a as A! 6 f O O 1 ?' .{;l. . Ali way,paru«pate t ,delay day; ,9+ai+my ' !,` }N. ti 10 '"' -a t1 ► Y required,hawcev ,zl ,o1 ated o rn 1. 'a`tnfc no n. „ moons ne,4gd.t tom► : '' ,: a n ,, .`, !! S PF '� �' iiJ N Itu ,1 ti. .� .alA"",J! A,,, ti applicatio rr.'irNk}su... `°�'. a ?a'_Fi F `'':"'i,' S' . . ,r.'6,4":'(`ib4:ik .,.... -. . c7. ...r:.s, . li..'+ .. R ...R. : , 11--6V6 SZ6,..-ea)LQ of spouse asking for waiver Printed name of spouse asking for waiver (Spouse of individual listed below) State of }Fg2k51LA„, County of ,tL-(_3 The foregoing instrument was acknowledged before me this I6 4& of 13021Aint / Zo f n by P Hama of n acknowledged edged -'� Affix Seal Risolhwilindhisllsvassodbilibidalq 1 I TAMI LARKIN Notary 'c signature 1 Omni Notary 1 4 State o1 Nebraska4 My Commission Expires Dec 1.2013 a /j w-7 - coin a ,v . 3. a rit x :..�i � {4 7 /, . .....,Yrf, �� ... ‘..5�.1 i,�i. a�l�: . AA11 .. z .....:r. Sir.-04� N.l ,� ..5.:. P Si o vidual involved with application Printed name of applying individual (Spo e o dividual listed above) State of 1�1eP v_.A- County of DetAen(./Y5 The foregoing instrument was acknowledged before me this I1,AL °"""d Ci 0 by 12er . li-ot6 date / name of person acknowledged L- �— Affix Seal TAMI l 11RKtN 1 1 General Notary 1 Notary lic signature 1 State o1 Nebraska 1 1 My Commission Expires Dee 1,2013 ♦ ► — - -� '� -- 4 In compliance with the ADA,this spousal affidavit of non participation is available in other formats for persona with disabilities. A ten day advance period is requested in writing to produce the alternate format. FORM 35-4178 Revised 112008 01,Apfl-9A, City of Omaha, Webrask, Aurw.0,44,,;:. �% 1 �� ,41111M- 1819 Farnam — Suite LC 1 �'t �1 �, .�i�� Omaha, Nebraska 68183-0112 0y..ter ' Buster Brown (402) 444-5550 ,v City Clerk FAX (402) 444-5263 0�,� 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. Sincerely yours, Buster Brown City Clerk BJB:clj • of individual listed below) State of }Fg2k51LA„, County of ,tL-(_3 The foregoing instrument was acknowledged before me this I6 4& of 13021Aint / Zo f n by P Hama of n acknowledged edged -'� Affix Seal Risolhwilindhisllsvassodbilibidalq 1 I TAMI LARKIN Notary 'c signature 1 Omni Notary 1 4 State o1 Nebraska4 My Commission Expires Dec 1.2013 a /j w-7 - coin a ,v . 3. a rit x :..�i � {4 7 /, . .....,Yrf, �� ... ‘..5�.1 i,�i. a�l�: . AA11 .. z .....:r. Sir.-04� N.l ,� ..5.:. P Si o vidual involved with application Printed name of applying individual (Spo e o dividual listed above) State of 1�1eP v_.A- County of DetAen(./Y5 The foregoing instrument was acknowledged before me this I1,AL °"""d Ci 0 by 12er . li-ot6 date / name of person acknowledged L- �— Affix Seal TAMI l 11RKtN 1 1 General Notary 1 Notary lic signature 1 State o1 Nebraska 1 1 My Commission Expires Dee 1,2013 ♦ ► — - -� '� -- 4 In compliance with the ADA,this spousal affidavit of non participation is available in other formats for persona with disabilities. A ten day advance period is requested in writing to produce the alternate format. FORM 35-4178 Revised 112008 U'. City of Omaha, Webras .-' it .,, /, , , it �® z,s 1 4,cm, or 1819 Farnam — Suite LC 1 �`.,�, t ;-- �li � �, Omaha, Nebraska 68183-0112 0�:;c xrJ.� , ' Buster Brown (402) 444-5550 �.0 _ �'' City Clerk FAX (402) 444-5263 o4,-, 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 e 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, .s,f roy.. , Buster Brown City Clerk BJB:clj The foregoing instrument was acknowledged before me this I6 4& of 13021Aint / Zo f n by P Hama of n acknowledged edged -'� Affix Seal Risolhwilindhisllsvassodbilibidalq 1 I TAMI LARKIN Notary 'c signature 1 Omni Notary 1 4 State o1 Nebraska4 My Commission Expires Dec 1.2013 a /j w-7 - coin a ,v . 3. a rit x :..�i � {4 7 /, . .....,Yrf, �� ... ‘..5�.1 i,�i. a�l�: . AA11 .. z .....:r. Sir.-04� N.l ,� ..5.:. P Si o vidual involved with application Printed name of applying individual (Spo e o dividual listed above) State of 1�1eP v_.A- County of DetAen(./Y5 The foregoing instrument was acknowledged before me this I1,AL °"""d Ci 0 by 12er . li-ot6 date / name of person acknowledged L- �— Affix Seal TAMI l 11RKtN 1 1 General Notary 1 Notary lic signature 1 State o1 Nebraska 1 1 My Commission Expires Dee 1,2013 ♦ ► — - -� '� -- 4 In compliance with the ADA,this spousal affidavit of non participation is available in other formats for persona with disabilities. A ten day advance period is requested in writing to produce the alternate format. FORM 35-4178 Revised 112008 Se e w o O C/� CD (...0 (o CD 0 • • vl CD el:J Pt 0 N � � • (AD 0 CD rD oi EA CD l•