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RES 2009-1332 - Appoint Ross E Olsbo manager of Old Chicago • F Pf 6 . fit ofOmaha, Webraskg :� 1I' 'co, � ,- 1819 Farnam Suite LC 1 "It ® 41° __ Omaha, Nebraska 68183-0112 0� „ Buster Brown (402) 444-5550 A AV City Clerk FAX (402) 444-5263 o4''TED FE�� t►1` November 10, 2009 Wadsworth Old Chicago, Inc. Application to appoint Ross E. Olsbo Dba"Old Chicao" manager of your present Class "I" 2643 South 144m Street Liquor License 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 November 24, 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, le4t Buster Brown City Clerk BJB:clj Cityof Omaha, fAlebras&atL \ air rwr G• \ lb.A 1819 Farnam — Suite LC 1 ®, r� . 4I � Omaha, Nebraska 68183-0112 0w er- Buster Brown (402) 444-5550 City Clerk FAX (402) 444-5263 0i FEBR�t►�`� November 10, 2009 Ross E. Olsbo Application to be appointed manager of the present 15963 Adams Street Class "I" Liquor License for Wadsworth Old Chicago, Omaha, NE 68135 Inc., dba"Old Chicago", 2643 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 24, 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, Buster Brown City Clerk BJB:clj BJB:clj �wv�lUl1\q\\\1 = THE ST4,TLp 1VA ��¢ii i ElJ = EIVED STATE OF NEBRASKA 191—,.s ,;' Dave Heineman 09 OCT 26 p� ; O. NEBRASKA LIQUOR CONTROL COMMISSION ` ''=� Governor 1 L O r-•. U Hobert B. Rupe $6�__= Executive Director 301 Centennial Mall South, 5th Floor CITY CLERK P.O.Box95046 OMAHA, NEBRASKA Lincoln,Nebraska 68509-5046 Phone(402)471-2571 Fax(402)471-2814 October 22, 2009 TRS USER 800 833-7352(TTY) web address:http://www.lcc.ne.gov/ OMAHA CITY CLERK 1819 FARNAM FC-1 OMAHA NE 68183 RE: OLD CHICAGO LICENSE #I - 46093 Dear Clerk: Enclosed is a copy of a manager application for Ross E Olsbo in connection with Old Chicago, located at 2643 S 144 Street in Omaha. Please present this application for manager to your City/Village Council or County Commissioners and send us the results of their action. Sincerely, Lyri . S make Licensing Division. • NEBRASKA LIQUOR CONTROL COMMISSION encl. cc: file • Janice M.Wiebusch Bob Logsdon Robert Batt Commissioner Chairman Commissoner An Equal Opportunity/Affirmative Action Employer Printed with soy ink on recycled paper clj BJB:clj „ . e, MANAGER APPLICATION Office Use RECE[VEp INSERT-FORM 3c •NEBRAS%A LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH NEB': N 4 BOX 950462009 • LINCOLN,NB 68509-5046 PHONE:(402)471-2571 FAX:(402)471-2814 NEBRASKA LIQUOR Webe;tz:www.lcc.ne.icov CONTROL COMMISSION Corporate manager,including spouse,are required to adhere to the following regsdreuants If spouse filed affidavit of non-participation fingerprints and proof of citizenship not required 1) Must be a cttleen of the United States 2) Must be a Nebraska resident(Chapter 2—006) 3) Must provide a copy of birth ate,naturalization paper or US passport 4) Must submit fiogerpriats(2 cards per pin) 5) Must be'21 years of age or older 6) Applicant may be required to take'a draining course �I•n �r t$u -�,�i�1.x� '� $ tf$' �' � .y t � .�F 1.rS�,-r t . �.s' � � < '�yr�� v .#„ ..��t-,1,. y .. .+'t F • �,��'�� r,y m'-�T, 'fi r F -t :1 �yl ed jrct Ay �' [ D e f 1 f1t F 7y1E �I. i t a, ' 4w Ste' �' � : x*` 4r :! `.'ter+ 'API,Ile '* t ".:t r4't}�S' hL' -xt.' °•! "'_ �, ,..iCf' 9C S:1 ... _ .L.- .16 .f �c. .. mt, Y . :ti'h .n. ., ..4M. w. >y�Fr. ...... ..yC. ...,. s .V� ..... ..r. -J[J-:rd� .04-1 ...a.6t ...t lit Wadsworth Old Chicago,Inc. Name of Corporation/LLC: 4iiiti�^ ,i� a.�- �: -�,., .�..;;��t�-fy�� � 'fit ,: ra -vr... !��^ Y` `� � y - ;�,--� i 146093 Promise License Number: _ (if new application leave blank) Premise Trade Name/DBA: Old Chicago f2M3 S 144thPremise Street Address: ... .., City: !Omaha Zip Code: 66144 Premise Phone Number:J(402)330-9001L_ vemommumummlimiarimm : 'E?tvr.4 4:r 4r*1:41 ii `,' a:?',i3 7 t , iF£^ '� .r � .: .: i 'F�”. i"•r"d li'� 3 ',. . CORPORATE OFFICER SIGNATURE axed si • :tures are : table Form 3c 0900019797 . , --- . , RECEIVED . ,. , e l' Sf, , p tgi ii L�++���tt r. },,,o A`, • ` l�'i4.:,, 1.•L'tS.'i7, r �,. - y .i. �F.. NEBRASKA LIQUOR Gender: (MALE ❑ FEMALE CONTROL COMMISSION Last Name: d I b0 First Name:----R05S MI: (- Home Home Address(include PO Box if applicable): 1516 3 1'ela_M� 5-r. City: 6 Ml A7 AA State: E Zip Code: f!¢5 1 3S • Home Phone Number:(.40Z) 9(Q 4-A.i 377 Business Phone Number: (402) 530 - R 0 0 t Social Security Number: _ _ .. , , - Drivers License Number&State: NE , . .__ _ __ _ Date Of Birth: r _ Place Of Birth: t.i Nco!,) ` �6. " w , ` s', cent A')use'--; ,�`� b (Even if i .fit i s C s'. . � srw� • '1- Sidi"'`• .ar''!�`-•"77�.� - j. .u.r L''€+7_ ®YES ❑NO • '' 4^ P v. 9 +'IMk ,� i :-- wif.�➢..r'!,s~i.�vA:WL,L...,..V •.Y' - _ y Sir� : Spouses Last Name: ©l Sbo First Name: MI: 5, Social Security Number: , _ _ Drivers License Number&State:CI)* Date Of Birth: -_ -' Place Of Birth: Cm 444�4 / /�}e - „-77 +gin- „, . +. ry+ .: j e,17 - - ,, w;waa .�7 'W'0 1 ; i A� 4 -1-i . - 4 a.,.4 a.y,/.~ - K;..'.T`,: . 7 y y • R '1`u CITY&STATE YEAR CITY&STATE YEAR FROM TO FROM TO Lay.k1..ul ec., K . t99g a,00l DvPIf A . Ai E a-oo t ooy Co Io,.Aao See(4q,i aooS SOB OrnA E o-ooS c:712 < Jry ,ram" � w ['NJ1lMT T yt + 1 i, S! c i YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER FROM TO 1/3Ai 90. ►t Old Ct. r(etc �"x 1331ra," SE.W 'Do,.t c,•va (4a))59 S-3116 . 9 1 1 Aac� ,JL JML A k�.I - 10°I 9a �� r M M • :tures are : table Form 3c 0900019797 RECEIVED 0 AA- :;- ` rg,r ,y. •-r .� i� +' .hYr.i , .C { Yd -�,��t, ro r te#9��.+ ,�") k.{, `�r lZ�'7 �.',�#c ;� v � N 4, k'2 ", 1„ ' y+tw.zw ,was f ="eWf .;Sc f � ., CONTROL COMM S�ON l. 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 narty,please list charges by each individual's name. OYES lNO 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. DYES ( NO 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 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) IYES FIND CITY&STATE YEAR FROM TO FROM TO Lay.k1..ul ec., K . t99g a,00l DvPIf A . Ai E a-oo t ooy Co Io,.Aao See(4q,i aooS SOB OrnA E o-ooS c:712 < Jry ,ram" � w ['NJ1lMT T yt + 1 i, S! c i YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER FROM TO 1/3Ai 90. ►t Old Ct. r(etc �"x 1331ra," SE.W 'Do,.t c,•va (4a))59 S-3116 . 9 1 1 Aac� ,JL JML A k�.I - 10°I 9a �� r M M • :tures are : table Form 3c 0900019797 , . RECE!VED. . . .. . ''le., M 4- N � .::''� S x i , - *f 5 j K'..f*. y• Y .'.•'i11, ,.'}'V, , ,.0 , r '.t:✓&. �r a .kr � ,1%:)f•f,. A 44,:iip'' ,.,t,'' ,,-2 <;;,,, ''6, 0ak', , w, ;'. t. ,,, p . ,. a, CON R The above individual(s),being first duly sworn upon oath,deposes and states that the undersigned s the'a MMl Wpouse 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. If spouse has NO interest directly or indirectly,a spousal affidavit of non participation may be attached. 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. 12LA f, 0Jr- A cii4 Signature of Manager Applicant Sign re of Spouse State of Nebraska County of —pout, ‘ft5 County of -Al iAK- The foregoing instrument was acknowledged before The foregoing instrument was acknowledged before me this c.,t a.e I r ?007 by me this e7,/„K,e I 20Q 4, by \ NoyPublicature ibny C. D /so N \ry Public signature � ..,,s, Affix Sea Affix Seal"- GENERAL NOTARY•State of Nebraska GENERAL NOTARY.State of Nebraska JASON W.BROWN J JASON W.BROWN My Comm.Exp.Sept 30.2012 •----_I1•—• My Comm.Exp.Sept.30,2012 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 5f2007 SPOUSAL AFFIDAVIT OF Office use RECEIV ir NON PARTICIPATION INSERT • NEBRASKA LIQUOR CONTROL COMMISSION JUN 4 20/t� 301 CENTENNIAL MALL SOUTH UJ Po BOX 95046 LINCOLN,NE 68509•5046 NEBRAS PHONE:(402)471-2571 IAA LIQUOR FAX:(402)471-2814 CONTROL COMMISSION Website; www.lcc.ne.gov dgee ft e spot alb 4....: , o der at e} 's at° a t ,„"Thy.'",' a I}ectl'}!rh ly:in;t13' tii t•or i' -' 25((i). i c' iquur trot A r yl* igot. p tei b ke.s , �e�'' ,,patrons,'s,0 triwrttet. ign�Inv prese>1b_ ei as� .weer' r°iron- '. �wa' clue m tfi�b�t�tlr y ola.• , lne? i ny nderstand m ei# r� wi1 n b re(y�t�� a,e i; abliigated t , igit an 411.iclos yulnforma %o liiapp1t i ,�- ,+e :p,•�p i ' x. •app 1sas , �, ! Y/ . C ?L s pY t_Y AnA 5. Okbo Signature f spouse asking for waiver Printed name bf spouse asking for waiver (Spouse of individual listed below) State of Eel2A5 County of /D(T-t8 1A 5 The foregoing instrument was acknowledged before me this 101fe5 by /40iii S- of ito date name of person acknowledged Affix Sac "..."...-.....- GENERAL NOTARY•State of Nebraska tary Public signature JASON W.BROWN My Comm.Exp,Sept 30,2012 it ag i1�'i',Wings- thetabo,:e. stpxl i dt t, u trr d" y� ,,are; ons e or;'" 1 i -w t co tdmonsu , 'at*• ei'•`I£.it� s to ' ' „ $it"fd',;duaal is vio ., ,( ' C,N e S17Y1� itF@ IeVOC °,.. InSeeS• s 5 .�' ;n: �d � r'1 ,. . . �._e :: 4 s1.1 "2)44 E. 64 4? 5s e. 61560 Signature of individual involved with application Printed name of applying individual (Spouse of individual listed above) State of N 6 6(2AAs totr County of 0)e,`A:S The foregoing instrument was acknowledged before me this OIDJdl / d1 by i65S �. D/ c, date name of person acknowledged Affix Sall '`~t�"""�" ff GENERAL NOTARY•State of Nebraska Notary Public signature JASON W.BROWN - — *Warn.Exp.Sept 30,2012 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 1R008 4 t3 n % a • Q' o0 CD ta. CD NOn -• � t• O p �• V, (D r+ n b7 C5 w C� � C ..io '4' pC 1-1 R R I 0C' 0 ° C�