RES 2009-1396 - Appoint Will Joor manager of Dave & Busters c1EsTA�E�n'hi RECEIVED
STATE OF NEBRASKA
F' " S S 4
a / u �, mil
NEBRASKA LIQUOR CONTROL COMMISSION
-,� � x ,Yw, Dave Heineman R�{ ►�
\,�'i 411 ''' Governor R Fits � Hobert B. Rupe
r Executive Director
301 Centennial Mall South, 5th Floor
CITY CLERK P.O.Box 95046
OMAHA, NEBRASKA Lincoln,Nebraska 68509-5046
Phone(402)471-2571
November 10, 2009 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: Dave & Buster's
LICENSE #I - 68065
Dear Clerk:
Enclosed is a copy of a manager application for Will Joor in connection with Dave & Buster's, located
at 2502 S 133 Plaza Suite 111 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,
d •
tri/P4
(.5L
Lake
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
ounty of
The foregoing instrument was acknowl ged before The foregoing instrument was acknowledged before
me this 4',2.7 Oc 4 o 6 a-oo9 by f•ci l N; R. me this by
•
Notary lic signature • Notary Public signature
•
Affix Seal Here Affix Seal Here
•
GENERAL NOTARY-State of Neb sl
ROGER FITZWATER
My Comm.Exp.Jan,2,20f0
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
I
Form 3c Page 4
MANAGER APPLICATION Mice Ilse
D
INSERT - FORM 3c
NEBRASKA LIQUOR CONTROL COMMISSION �,..,.
301 CEN'1'LNNIAL MAT,L SOUTH ,I;; F r,:
PO BOX 95046
L1NC(,)LN,NE 68509-5046
PHONE:(402)471-2571 i 3 '6RASKA UCATO
FAX:(402)471-2814 .L:ON.TROL COMMISSION
Website:www,lcc,ne,gov
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 fingerprints(2 cards per person)
5) Must be 21 years of age or older
6) Applicant may be required to take a training course
k
� -..-�
Name of CoxporatiolllLLC:�a j u Q rJlAs�kj-C I�S i\10..1,2056..) J L. .
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Premise License Number: (kat �
WC
(if new application leave blank)
Premise Trade Name/DBA: 3 ` S4( /5
Premise Street Address:69,5 ). S . 133r11—PI 2, ) Lt►. (\1
City: UVW.-. Zip Code: Lft1
Premise Phone Number: @Q2 1-f 8 — 3 i
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CORPORATE OFFICER SIGNATURE Ja L TTobtn i V P
(Faxed signatures are acceptable) '.2CC._tt ..W1_....
Form 3c III 11 11 1 1 1 11 11 11 11 11
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Gender: . MALE 3 [J FEMALE
Last Name: icor First Name: Wi LZ MI:
Home Address (include PO Box if applicable): 302K . I i jtCNU''
City: CAAA A 0 A State: /U Zip Code: 6S/30
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Home Phone Number: ��� • 3Sa /26_2__ Business Phone Number: 77 307
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Social Security Number: ___ _--_. -. --- —' Drivers License Number& State: - ^ , — -
Date Of Birth: Place Of Birth: 6/1-EC-Wifia‘ , ,ZL•
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Date Of Birth: '•_-- r Place Of Birth: le.. d re, �F"
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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.
.�, :`l,�tip s' �
nYES k ,�40 If yes,please explain below or attach a separate page. ` "°"A° `
fiatiPASK iQUO `
c:om ROL DOPA ft is; 10
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 , ht[ O
3. Do you, as a manager,have all the qualifications required to hold a Nebraska Liquor License? Nebraska
Liquor Control Act(§53-131.01)
�ES TNO
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$38.00 per person)
fYES fNO
5. Do you have any experience in selling alcohol in the State of Nebraska?
If so list training and/or experience (when and where)
Date: Where: A�
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Form 3c Page 3
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Form 3c ' Pag e 2
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The above individual(s),being first duly sworn upon oath, deposes and states that the undersigned is the applicant and/or spouse
of applicant who makes the above and foregoing application that said application has been read and that the contents thereof and
all statements contained therein arc true. If any false statement is made in any part of this application, the applicant(s) shall be
deemed guilty of perjury and subject to penalties provided by law. (Sec §53-131.01)Nebraska Liquor Control Act.
The undersigned applicant hereby consents to an investigation of his/her background including all records of every kind and
description including police records, tax records (State and Federal), and bank or lending institution records, and said applicant
and spouse waive any rights or causes of action that said applicant or spouse may have against the Nebraska Liquor Control
Commission and any other individual disclosing or releasing said information to the Nebraska Liquor Control Commission.
The undersigned understand and acknowledge that any license issued, based on the information submitted in this application, is
subject to cancellation if the information contained herein is incomplete, inaccurate,or fraudulent.
•
51.44:71 oat
Signature of Manager Applicant Signature of Spouse
State of Nebraska
County of av yzar-s County of ed✓„i,,'f.
The foregoin instrument was acknowledged before The foregoing instrument was acknowledged before
me this r[/Z/0 9 by me this /0 Jv aj by
Notary Public signature otary Public signature
Affix Seal IIere Affix Seal Here
ralGENERAL NOIARYSta rsof Nebraska ( 1J$iAL NOTARYSta�e of Nebrasln
KYLE PETERS KYLE PETERS
My Comm.4.Oct.22,2013 .. �. My Ctxrm E>at Oct 22 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 liwrnat.
Revised 9/2008
Form 3c
Page 4 1
...wa. - =.~r „_ .jy-'"".' -s:t. fir -�- • _ cs - -fie i yr.I. w._: --'• "�. ..:.._ '
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Form 3c ' Pag e 2
SPOUSAL AFFIDAVIT OF Office Use 44
NON PARTICIPATION INSERT t...,w".z ,,, , ,..Y
NEBRASf(A LIQUOR CONTROL COMMISSION
301 CENTENNIAL MALL SOUTH 1 4.
PO BOX 95046
LINCOLN,NE 68509-5046
PHONE:(402)471-2571
FAX:(402)471-2814 ;Ai :" iS~l .t�iQUO
Website: wwwiec,ne,gov
"t' 'i OLCOMMISSION
I acknowledge that I am the spouse of a liquor license holder. My signature below confirms that I will have not have any
interest,directly or indirectly in the operation or profit of the business.(§53.125(13))of the Liquor Control Act. I will not
tend bar,make sales,serve patrons, stock shelves,write checks,sign invoices or represent myself as the owner or in any
way participate in the day to day operations of this business in any capacity. I understand my fingerprint will not be
required;however,I am obligated to sign and disclose any information on all applications needed to process this
application.. . .
2)(4.4.4.-1 ef JtC'R
Signature of spot e asking for waiver Printed name of spouse askingfor waiver
p
(Spouse of individual listed below)
State of /(lFJ.e4.sk'4
County of Odiv c e.ps-{ The foregoing instrument was acknowledged before me this
Oit/09 by Perms
date name of person acknowledged
Affix Seal
State of Nebraska
Notary Public signature ORAL KYLE PETERS
My Corms En).Oct 22,2013
acknowledgethat Ion the spouse of the above listed individual. I understand that my spouse and I are.responsible for.
compliance with the:conditions set out above. If it is determined that the:above individual has-violated(§5;3-125(13))the
Commission may cancel or.revoke the liquor license.
Signature a '.:. '' if:1 involved with application Printed name of applying individual
(Spouse of individual listed above)
State of ./(k/sicis t4
County of lay Sw4-1 The foregoing instrument was acknowledged before me this
( I)Z O't by 13Le. P -8r5
date name of person acknowledged
tAffix Seal
togEPIERALNotary Public signature L NOTARY-StaleNt �a
KYLE PETERS
My Cartm.Fes.Oct 22,2013
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
Z/0 9 by me this /0 Jv aj by
Notary Public signature otary Public signature
Affix Seal IIere Affix Seal Here
ralGENERAL NOIARYSta rsof Nebraska ( 1J$iAL NOTARYSta�e of Nebrasln
KYLE PETERS KYLE PETERS
My Comm.4.Oct.22,2013 .. �. My Ctxrm E>at Oct 22 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 liwrnat.
Revised 9/2008
Form 3c
Page 4 1
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.7"-"�----'�5 -,a"a. -- .. r . .-.__ 4.r... �•--,-_ -" - ...1s- -i _ .�.._, :- ice=: _.
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Form 3c ' Pag e 2
Opli.� A,tc
gi
City ofOmaha fAfebraskg °��
77'
1819 Farnam— Suite LC 1 2 «�
Omaha, Nebraska 68183-0112 0�.w ,;� ;a,M,. .�
Buster Brown (402) 444-5550 �A ,. �''
City Clerk FAX (402) 444-5263 O97'E p FEB° A
November 23, 2009
Dave & Buster's of Nebraska, Inc. Application to appoint Will Joor
Dba"Dave & Buster's" manager of your present Class "I"
2502 South 133`d Plaza, Suite 111 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 December 8,
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.
Sincer y yours,
Buster Brown
City Clerk
BJB:clj
Seal
State of Nebraska
Notary Public signature ORAL KYLE PETERS
My Corms En).Oct 22,2013
acknowledgethat Ion the spouse of the above listed individual. I understand that my spouse and I are.responsible for.
compliance with the:conditions set out above. If it is determined that the:above individual has-violated(§5;3-125(13))the
Commission may cancel or.revoke the liquor license.
Signature a '.:. '' if:1 involved with application Printed name of applying individual
(Spouse of individual listed above)
State of ./(k/sicis t4
County of lay Sw4-1 The foregoing instrument was acknowledged before me this
( I)Z O't by 13Le. P -8r5
date name of person acknowledged
tAffix Seal
togEPIERALNotary Public signature L NOTARY-StaleNt �a
KYLE PETERS
My Cartm.Fes.Oct 22,2013
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
Z/0 9 by me this /0 Jv aj by
Notary Public signature otary Public signature
Affix Seal IIere Affix Seal Here
ralGENERAL NOIARYSta rsof Nebraska ( 1J$iAL NOTARYSta�e of Nebrasln
KYLE PETERS KYLE PETERS
My Comm.4.Oct.22,2013 .. �. My Ctxrm E>at Oct 22 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 liwrnat.
Revised 9/2008
Form 3c
Page 4 1
...wa. - =.~r „_ .jy-'"".' -s:t. fir -�- • _ cs - -fie i yr.I. w._: --'• "�. ..:.._ '
.7"-"�----'�5 -,a"a. -- .. r . .-.__ 4.r... �•--,-_ -" - ...1s- -i _ .�.._, :- ice=: _.
-..s.. r�-^...�ti:e.--.t: •m:• is _'%?�+• _''s.._,� � ..,. .'r--'
Form 3c ' Pag e 2
•
City o Omaha .fie bras ,� ��1164. �
MI*AfI4,44.11A
1819 Farnam—Suite LC 1 2
S �''•+;M,. 1,
Omaha, :a. \r`'"*.
Nebraska 68183-0112 o�A t : �,,,.:_�__ ;.-? .
Buster Brown (402) 444-5550
City Clerk FAX (402) 444-5263 0,p94'
o FE 8O T.A
November 23, 2009
Will Joor Application to be appointed manager of the present
3024 South 160d' Avenue Class "I" Liquor License for Dave & Buster's of
Omaha,NE 68130 Nebraska, Inc., dba "Dave & Buster's", 2502 South
133`d Plaza
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 December
8, 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,
ZLI,,evez
Buster Brown
City Clerk
BJB:clj
22,2013
acknowledgethat Ion the spouse of the above listed individual. I understand that my spouse and I are.responsible for.
compliance with the:conditions set out above. If it is determined that the:above individual has-violated(§5;3-125(13))the
Commission may cancel or.revoke the liquor license.
Signature a '.:. '' if:1 involved with application Printed name of applying individual
(Spouse of individual listed above)
State of ./(k/sicis t4
County of lay Sw4-1 The foregoing instrument was acknowledged before me this
( I)Z O't by 13Le. P -8r5
date name of person acknowledged
tAffix Seal
togEPIERALNotary Public signature L NOTARY-StaleNt �a
KYLE PETERS
My Cartm.Fes.Oct 22,2013
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
Z/0 9 by me this /0 Jv aj by
Notary Public signature otary Public signature
Affix Seal IIere Affix Seal Here
ralGENERAL NOIARYSta rsof Nebraska ( 1J$iAL NOTARYSta�e of Nebrasln
KYLE PETERS KYLE PETERS
My Comm.4.Oct.22,2013 .. �. My Ctxrm E>at Oct 22 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 liwrnat.
Revised 9/2008
Form 3c
Page 4 1
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Form 3c ' Pag e 2
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