RES 2009-1164 - Appoint Gyanendra Bhandari manager of The Jaipur yLE`S T`3 T rrh
Aoh
z o F EIVEU
'y „,i STATE OF NEBRASKA
,r, Dave Heineman 09 SEP O0 t: . i, NEBRASKA LIQUOR CONTROL COMMISSION
li Governor Hobert B. Rupe
V 6_/ Executive Director
w....:..- 301 Centennial Mall South, 5th Floor
CITY CLERS P.O.Box 95046
OMAHA, N E 5:R.A t;, /` Lincoln,Nebraska06)509 5046
Phon71-2571
September 25, 2009 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: EVEREST BREW HOUSE INC DBA THE JAIPUR
LICENSE #C 66975 L 67040
Dear Clerk:
Enclosed is a copy of a manager application for Gyanendra Bhandari in connection with The Jaipur,
located at 10922 Elm Street in Omaha, NE 68144. . •
Please present this application for manager to your City/Village Council or County Commissioners and
send us the results of their action.
Sincerely, •
Aif
/4/111104 •
Ly . •• . e
Licensing Division
NEBRASKA LIQUOR CONTROL COMMISSION
encl.
cc: file
•
Janice M.Wiebusch Bob Logsdon Robert Batt
Commissioner Chairman Cormsssoner
An Equal Opportunity/Affirmative Action Employer
Printed with soy ink on recycled paper
ny license issued,based on the information submitted in this application,is
subject to cancellation if the information contained herein is incomplete,inaccurate,or fraudulent.
Signature of Manager Applicant Signature of Spouse
State of Nebraska
hGd
County of '0 County of
The foregoing instrument was acknowledged before The foregoing instrument
was acknowledged before
me this y4,+nll- S�,r(.11,60q by me this ? � S I Zte9 by
c s ature to Pu c si afore
Affix Seal Here Affix S > '€�'< THOMAS C.GREEN II
:GE.V;T;"" MY COMMISSION EXPIRES
:i::
?'iaOMA . �' o..AY:"=
s � i': MISSCSIONGREENII EXPIRES June 1,2011
i i, June 1,2011
ry
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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Spouses Last Name: Bhandan. ... • _.. .. : First Name:15mritt ,. .__-.... . - MI: :R
Social Security Number: ._....,__.. ._.___.._...._n__.,.___..«_... Drivers License Number& State: N.E ., :_..
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Date Of Birth: .... ....-=M.;_.„_... ...... . _... __.. Place Of Birth:, Kathmandu,Nepal ,
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•CITY.&STATE • YEAR CITY&STATE YEAR •
FROM TO FROM TO
Omaha,NE 2000 Present �maha NE 2001 1 Present
New York City,NY 111997 12000 Boston,MA 1 2000 112001
l.. ,__,.,w_� _. iBoulde,r,C0 .. ...., _._ _ ._... , ..._... .. ._.. 2000 1
kathm anu_dNepal _� ,., .....,.__ m. ..1999 000
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YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER
FROM TO
2004 'Present 11,Everest Brew House,Inca Self 1 402-392 7331
2002 2004 imal&Associates ,Steve Gordon y
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MANAGER APPLICATION Office Use •
INSERT-FORM 3c
•
NEBRASKA LIQUOR CONTROL COMMISSION ,
3010ENTENNIAL MALL SOUTH ,
_
PO BOX 95046 -
PO � a
LINCOLN,NE 68509-5046 l4
PHONE:(402)471-2571
FAX:(402)471-2814 •
Website:www.lcc.ne.gov S E P 2 52063
Corporate manager,including spouse,are required to adhere to the following requirements NEBRASKA 3RASf1 LIQUOR
If spouse.filed affidavit of non-participation fingerprints and proof of citizenship not required CONTROL 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
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Everest Brew House,Inc.
Name of Corporation/LLC: __.._._._.__..__-_- ___._.._._ _ __..__
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Premise License Number:. 166975&67040 j
(if new application leave blank) � �
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Premise Trade Name/DBA: The Jaipur
10922 Elm Street •
Premise Street Address: i
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Omaha Zip Code: j68.144 C
_ _�_ _ ___-_.__.....�.,^-.T..-, _
402-392-7331 I 1
Premise Phone Number: +_.___,.._._.____._-_.__
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CORPORATE OFFICER SIGNATURE
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Gender: E MALE ;-_ FEMALE .
Last Name: fhandarL i First Name: 'Gyanendra !N/A
`2524 North 166th Avenue I
Home Address (include PO Box if applicable): ' ___._____._._____._______... z ._..___.__ _.._.______._ r�__..._ ._.___+
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City Omaha 1 ..State. NE_.__ I •Zip Code: 68.116
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402 993 5758 402 392 7331
Home Phone Number: __W._ ___.__.___.__ _.-___I Business Phone Number: =--"- - — -..1
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Social Security Number: •-- -�- - -•---�•�-- -`-' Drivers License Number& State: Li--.------------. --il
Date Of Birth: Place Of Birth: IKathmandy Nepal __ _ _
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Spouses Last Name: Bhandari__"_.. —m . First Name:5-mriti—,. MI: R E
Social SecurityNumber: ...-....,....._..-_ ...._- , _ ._.�...__.-_t Drivers License Number& State: 'NE
Date Of Birth:
__.__..__ __.____ _.____I Place Of Birth:J'''Kathmandu_Nepal _ _ .__...__
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CITY&STATE • YEAR CITY&STATE YEAR
• FROM TO FROM TO •
Omaha,NE 2000 ;Present maha,NE 2001 Present
ew York City,NY 0997 1,2000 ;Boston MA 112000 112001 f
rl Boulder,CO 2000
' kathrriandu,Nepal P 1999
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YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER
FROM TO •
:2004 I Present i;Everest Brew House,Inc. �Self 1402-392-7331
2002 i12004 ••
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Form 3c Page 2
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iti �}• t � _ .: r.. r �'. 3 Y � ct't.., t�'t� t �a a r
Manager and spouse u ev euy an°< th tyy ns b" YAg
,; yy'I
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.p- a ..
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.
- i
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.
OYES ONO
C & &to )-bue , Thy . d/ /a. The Jcolour
3. Do you, as a manager,have all the qualifications required to hold a Nebraska Liquor License? Nebraska
Liquor Control Act(§53-131.01)
Efi 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)
DYES IINO
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:
2002 to Present The Jaipur-worked as waiter and bartender
Form 3c Page 3
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Spouses Last Name: Bhandari__"_.. —m . First Name:5-mriti—,. MI: R E
Social SecurityNumber: ...-....,....._..-_ ...._- , _ ._.�...__.-_t Drivers License Number& State: 'NE
Date Of Birth:
__.__..__ __.____ _.____I Place Of Birth:J'''Kathmandu_Nepal _ _ .__...__
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CITY&STATE • YEAR CITY&STATE YEAR
• FROM TO FROM TO •
Omaha,NE 2000 ;Present maha,NE 2001 Present
ew York City,NY 0997 1,2000 ;Boston MA 112000 112001 f
rl Boulder,CO 2000
' kathrriandu,Nepal P 1999
, 7f4 K" qA V" £ (C f�c Y?i -i a•. Y r it:G 0 i;a•b.' 4:\ -,ovi`.• ',, sr :�' "ri� >i ilit" ff .:, .J ,v7 ,
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ir
YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER
FROM TO •
:2004 I Present i;Everest Brew House,Inc. �Self 1402-392-7331
2002 i12004 ••
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Form 3c Page 2
A
, 6 , l 4 Plg N w ph S ;
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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.
Signature of Manager Applicant Signature of Spouse
State of Nebraska / ^
f/Ld
County of -'0 (� County of
i
The foregoing instrument was acknowledged before The foregoing instrument was acknowledged before
me this 1, jai 'i.' 2o' by me this z3111f A sr, 209 by
N a c s ature to Pu c si afore
Affix Seal Here Affix S4REENHE# ;QF`411 � i
Ofi Ate:C.GREEN II = :t10TARY; COMMISSION EXPIRES
P k ;jM,ia9Idas e, June 1,2011
:� Noeaex' lune1,SSI0N2011EXPIRES
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
00 per person)
DYES IINO
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:
2002 to Present The Jaipur-worked as waiter and bartender
Form 3c Page 3
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„eq
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Spouses Last Name: Bhandari__"_.. —m . First Name:5-mriti—,. MI: R E
Social SecurityNumber: ...-....,....._..-_ ...._- , _ ._.�...__.-_t Drivers License Number& State: 'NE
Date Of Birth:
__.__..__ __.____ _.____I Place Of Birth:J'''Kathmandu_Nepal _ _ .__...__
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CITY&STATE • YEAR CITY&STATE YEAR
• FROM TO FROM TO •
Omaha,NE 2000 ;Present maha,NE 2001 Present
ew York City,NY 0997 1,2000 ;Boston MA 112000 112001 f
rl Boulder,CO 2000
' kathrriandu,Nepal P 1999
, 7f4 K" qA V" £ (C f�c Y?i -i a•. Y r it:G 0 i;a•b.' 4:\ -,ovi`.• ',, sr :�' "ri� >i ilit" ff .:, .J ,v7 ,
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ir
YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER
FROM TO •
:2004 I Present i;Everest Brew House,Inc. �Self 1402-392-7331
2002 i12004 ••
,xz;:•. ,,.r ti-1,,:,• r} r 5i ry:; -7,t,7 " Fh;,7:7'v.:7".�zK- a _ .,.rsr�1 ri Yt k• 'x'-:•s. r'z:ts. t, Y
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Form 3c Page 2
r D�pHr1 NF
cityofOmaha, Nebrass a y,C.) "ram 7'
4„,,,, ,
rtr,
1819 Farnam— Suite LC 1 'f ,,
i,
Omaha, Nebraska 68183-0112 0 v.r, .N41. :,. r 17:y. 1,'
Buster Brown (402) 444-5550 'p4 �'
City Clerk FAX (402) 444-5263 o,l) FEgik9-
October 6, 2009
Everest Brew House, Inc. Application to appoint Gyanendra
Dba "The Jaipur" Bhandari manager of your present Class
10922 Elm Street "C"and "L" Liquor Licenses
Omaha, NE 68144
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 October 20,
2009 . 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,
" p er"`"ric;‘,Ze
Buster Brown
11
City Clerk
BJB:clj
County of -'0 (� County of
i
The foregoing instrument was acknowledged before The foregoing instrument was acknowledged before
me this 1, jai 'i.' 2o' by me this z3111f A sr, 209 by
N a c s ature to Pu c si afore
Affix Seal Here Affix S4REENHE# ;QF`411 � i
Ofi Ate:C.GREEN II = :t10TARY; COMMISSION EXPIRES
P k ;jM,ia9Idas e, June 1,2011
:� Noeaex' lune1,SSI0N2011EXPIRES
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
00 per person)
DYES IINO
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:
2002 to Present The Jaipur-worked as waiter and bartender
Form 3c Page 3
. -S�1 G '
„eq
Sose n : -f-'. Sk ;.. µ 1T .� , � � Tw+' .+ cc 4 `.r 6t1' � F ... .- r"4`rn4�.
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' Y ., '�
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m'
Spouses Last Name: Bhandari__"_.. —m . First Name:5-mriti—,. MI: R E
Social SecurityNumber: ...-....,....._..-_ ...._- , _ ._.�...__.-_t Drivers License Number& State: 'NE
Date Of Birth:
__.__..__ __.____ _.____I Place Of Birth:J'''Kathmandu_Nepal _ _ .__...__
y�yrrF'+`M cr t ha'a;fi*''• •"'4� a u t5a � -,y,*._. �m �h .,.z;di a.,. - � f -
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CITY&STATE • YEAR CITY&STATE YEAR
• FROM TO FROM TO •
Omaha,NE 2000 ;Present maha,NE 2001 Present
ew York City,NY 0997 1,2000 ;Boston MA 112000 112001 f
rl Boulder,CO 2000
' kathrriandu,Nepal P 1999
, 7f4 K" qA V" £ (C f�c Y?i -i a•. Y r it:G 0 i;a•b.' 4:\ -,ovi`.• ',, sr :�' "ri� >i ilit" ff .:, .J ,v7 ,
w,; 1 . '' .F N .4,aNAG S.L 'IWO Ei L;O .rj� t ,� � s T ' .1, tc' -+ Y'eP • ti eaffi' .rs.kI +• ,' ZI,r .rta ? wi:!.WA4.:,- ... ,.s ..:.Y .ma.. itiif ,v4, nYa>.� ....:,< -.'.. t ; ,i ,, � .:,•.,4
ir
YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER
FROM TO •
:2004 I Present i;Everest Brew House,Inc. �Self 1402-392-7331
2002 i12004 ••
,xz;:•. ,,.r ti-1,,:,• r} r 5i ry:; -7,t,7 " Fh;,7:7'v.:7".�zK- a _ .,.rsr�1 ri Yt k• 'x'-:•s. r'z:ts. t, Y
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Form 3c Page 2
y. ,,►City ofOmaha, Webraskg
4 ` „ .it� Jp
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r.
1819 Farnam Suite LC 1 p� 1, - ., __
Omaha, Nebraska 68183-0112 0.,.Z & . :
Buster Brown (402) 444-5550 ' �A �''
City Clerk FAX (402) 444-5263 0��'TFp FEa ��*-�
October 6, 2009
Gyanendra Bhandari Application to be appointed manager of the present
2524 North 166th Avenue Class "C" & "L" Liquor Licenses for Everest Brew
Omaha, NE 68116 House, Inc., dba "The Jaipur", 10922 Elm 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 October 20,
2009. 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,
r
47
,, 1 ..0,/,‘(:75,4
Buster Brown
City Clerk
BJB:clj
County of
i
The foregoing instrument was acknowledged before The foregoing instrument was acknowledged before
me this 1, jai 'i.' 2o' by me this z3111f A sr, 209 by
N a c s ature to Pu c si afore
Affix Seal Here Affix S4REENHE# ;QF`411 � i
Ofi Ate:C.GREEN II = :t10TARY; COMMISSION EXPIRES
P k ;jM,ia9Idas e, June 1,2011
:� Noeaex' lune1,SSI0N2011EXPIRES
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
00 per person)
DYES IINO
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:
2002 to Present The Jaipur-worked as waiter and bartender
Form 3c Page 3
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Spouses Last Name: Bhandari__"_.. —m . First Name:5-mriti—,. MI: R E
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Date Of Birth:
__.__..__ __.____ _.____I Place Of Birth:J'''Kathmandu_Nepal _ _ .__...__
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CITY&STATE • YEAR CITY&STATE YEAR
• FROM TO FROM TO •
Omaha,NE 2000 ;Present maha,NE 2001 Present
ew York City,NY 0997 1,2000 ;Boston MA 112000 112001 f
rl Boulder,CO 2000
' kathrriandu,Nepal P 1999
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ir
YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER
FROM TO •
:2004 I Present i;Everest Brew House,Inc. �Self 1402-392-7331
2002 i12004 ••
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Form 3c Page 2
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