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RES 2009-1090 - Appoint James J Nelson manager of 801 Chop House l_o4,�ttE S�T,gT�yp, �'„, STATE OF NEBRASKA 4,wtrA �u y,% Dave Heineman R b.l:.r I V tL Li NEBRASKA LIQUOR CONTROL COMMISSION a;,�;s Governor 5@e+ I Hobert B. Rupe �'•j__; . ,y 14C\ .•!., II ^ Executive Director 301 Centennial Mall South, 5th Floor P.O.Box 95046 C i .i C:.. :t Lincoln,Nebraska 68509-5046 OMAHA, NEBRASKA Phone(402)471-2571 Fax(402)471-2814 August 28, 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: PAXTON CHOP HOUSE LLC; DBA: 801 CHOP HOUSE LICENSE #C 73674 Dear Clerk: Enclosed is a copyof a manager application for James J Nelson in connection with 801 Chophouse, 9 pp p located at 1403 Farnam Street in Omaha, NE 68102. Please present this application for manager to your City/Village Council or County Commissioners and send us the results of their action. Sin -rely, a . tab Lynn Shumake Licensing Division • NEBRASKA LIQUOR CONTROL COMMISSION encl. cc: file • Robert Batt Bob Janice M.WiebuschLogsdon Commissioner Chairman Commissoner An Equal Opportunity/Affirmative Action Employer Printed with soy ink on recycled paper ed before The foregoing instrument was acknowledged before me this 7 /5-ref'' by me this by 14..E / o 7, a Notary Public signirure Affix sal Hare Affix seal Hare GENERAL NOTARY.State of Nebraska ,ri GINGER GUIIfOYLE - My Comm.Exp.Aug,15,2011 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 9/2OtS Form 3c Page 4 :'',Ir• ., -.„ , ,.. , - 411.4* 1 Form 3c Page 2 .:?Cx..::��� .�ri "s�.;.i. ..:...": CITY&STATE YEAR YEAR - FROM TO FROM TO a .fir... 1 . , 1 _1,• i u. tilt . 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I14{Z r, '.- ._ ... . 0% SO- FI r 60 I ti Form 3c Page 2 .table Form 3c 0900016458 . _ MANAGER APPLICATION Office Use INSERT-FORM 3c RECEIVED (�c NEBRASKA LIQUOR CONTROL COMMISSION ■ ` IVED 301 CENTENNIAL MALL SOUTH PO LINCOLN,BOX 95046 N }UN a 0 2009 NE 68509-5046 .JE PHONE:(402)471-2571 • FAX:(402)471-2814 Website:www.icc.nc.gov NEBRASKA LIQUOR CONTROL COMMISSION 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 - RECEIVED 2) Must be a Nebraska resident(Chapter 2—006) 3) Must provide'sleepy of birth certificate,naturalization paper or US passport AUG 2 6 2009 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 NEBRASKA LIQUOR CON/T401,cOMMisclnN Name of Corporation/LLC: PAXTON CHOP HOUSE, LLC 73674 Premise License Number: (if new application leave blank) Premise Trade Name/DBA: .. 801 CHOP HOUSE AT THE PAXION Premise Street Address: 1403 I'ABNAN('1STREET City: OMAHA Zip Co e: 68102 Premise Phone Number: (402) 341-1222 A7q74pd 7 A) 11..d!/4.. , 6 9, • CORPORATE OFFICER SIGNATURE Faxed Si: atures are acce•table ,. Ei 1„ Him it • Form 3c 0900016460 y 14..E / o 7, a Notary Public signirure Affix sal Hare Affix seal Hare GENERAL NOTARY.State of Nebraska ,ri GINGER GUIIfOYLE - My Comm.Exp.Aug,15,2011 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 9/2OtS Form 3c Page 4 :'',Ir• ., -.„ , ,.. , - 411.4* 1 Form 3c Page 2 .:?Cx..::��� .�ri "s�.;.i. ..:...": CITY&STATE YEAR YEAR - FROM TO FROM TO a .fir... 1 . , 1 _1,• i u. tilt . I�W_: --- - - - - - im. ,�.,fi�tt+� r•' .T�y' '--I .yam, s M_- r a�. » -r, sIPte,.j3 y ^ 3h''.ik%x, .i^.s.i..: - :zra:. .. . . ,9'9�' •k's_ d.n-.•. .. •341, a—. •c.......- ,.......• ,..6.1.. ,;s§14. .k 14Z'. •4-Gi .,n• YEAR NAME OF EMPLOYER NAME OF SUPERVISO' TELEPHONE NUMBER FROM TO 1 �._. I14{Z r, '.- ._ ... . 0% SO- FI r 60 I ti Form 3c Page 2 .table Form 3c 0900016458 . Gender: n MALE ■ FEMALE Last Name: lvU1,soh First Name: Tavrcr_S MI: • Home Address (include PO Box if applicable): I Oa 4 Ule:1j. 5+. *5Q,2 City: at.a State: NE Zip Code: 6 s 102 Home Phone Number: 713. - 31 D- l l'?cf Business Phone Number; 4-O - 3 41. l�. Social Security Number:_ ' - Drivers License Number& State: . ___ _ Date Of Birth: Place Of Birth: ( uv ,,p ®YES ❑NO Spouses Last Name: /Vtlbon First Name: 1 i,c .k MI: r Social Security Number: _ __ — Drivers License Number& State: IA — Date Of Birth: _Place Of Birth: �vv►L i t EL.4 CC, I A. • CITY&STATE YEAR CITY&STATE YEAR FROM TO FROM TO 10111111. MATI ! Mir ■G '! YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER FROM TO IMO 00 r ..: . . MINFAIREMII Form 3c Page 2 rporation/LLC: PAXTON CHOP HOUSE, LLC 73674 Premise License Number: (if new application leave blank) Premise Trade Name/DBA: .. 801 CHOP HOUSE AT THE PAXION Premise Street Address: 1403 I'ABNAN('1STREET City: OMAHA Zip Co e: 68102 Premise Phone Number: (402) 341-1222 A7q74pd 7 A) 11..d!/4.. , 6 9, • CORPORATE OFFICER SIGNATURE Faxed Si: atures are acce•table ,. Ei 1„ Him it • Form 3c 0900016460 y 14..E / o 7, a Notary Public signirure Affix sal Hare Affix seal Hare GENERAL NOTARY.State of Nebraska ,ri GINGER GUIIfOYLE - My Comm.Exp.Aug,15,2011 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 9/2OtS Form 3c Page 4 :'',Ir• ., -.„ , ,.. , - 411.4* 1 Form 3c Page 2 .:?Cx..::��� .�ri "s�.;.i. ..:...": CITY&STATE YEAR YEAR - FROM TO FROM TO a .fir... 1 . , 1 _1,• i u. tilt . I�W_: --- - - - - - im. ,�.,fi�tt+� r•' .T�y' '--I .yam, s M_- r a�. » -r, sIPte,.j3 y ^ 3h''.ik%x, .i^.s.i..: - :zra:. .. . . ,9'9�' •k's_ d.n-.•. .. •341, a—. •c.......- ,.......• ,..6.1.. ,;s§14. .k 14Z'. •4-Gi .,n• YEAR NAME OF EMPLOYER NAME OF SUPERVISO' TELEPHONE NUMBER FROM TO 1 �._. I14{Z r, '.- ._ ... . 0% SO- FI r 60 I ti Form 3c Page 2 .table Form 3c 0900016458 . 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'; name. ©YES ONO If yes,please explain below or attach a separate page, Mi..eyc i,n l ky.ea.t !� cared C...OQV e\ $1,34s, TA * 2.000 RECEIVED Ate, 0 6 2009 gaig,SKA LIQUOR 2. Have you or your spouse ever been approved or made application for a 1Et041gpliellgIltior any other state? IF YES,list the name of the premise. DYES ENO 3. Do you, as a manager,have all the qualifications required to hold a Nebraska Liquor License? Nebraska Liquor Control Act(§53-131.01) [AYES ENO 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 f � �Q nernersund —_ — — A*flJi M $$* Ut F-1;Yrifittel N to iVNA ua ONO omit m.m1 'MOM lamest) 1100101I Is MM a t *Iwo a+nweo3+!r 5. I• 's • - - .. selling alcohol in the State of 4 bra Eca?— so list training and/or experience(when and where) Date: Where: Il/2.00g O41.vke. rsdt_ 410,•ae Form 3c Page 3 GENERAL NOTARY.State of Nebraska ,ri GINGER GUIIfOYLE - My Comm.Exp.Aug,15,2011 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 9/2OtS Form 3c Page 4 :'',Ir• ., -.„ , ,.. , - 411.4* 1 Form 3c Page 2 .:?Cx..::��� .�ri "s�.;.i. ..:...": CITY&STATE YEAR YEAR - FROM TO FROM TO a .fir... 1 . , 1 _1,• i u. tilt . I�W_: --- - - - - - im. ,�.,fi�tt+� r•' .T�y' '--I .yam, s M_- r a�. » -r, sIPte,.j3 y ^ 3h''.ik%x, .i^.s.i..: - :zra:. .. . . ,9'9�' •k's_ d.n-.•. .. •341, a—. •c.......- ,.......• ,..6.1.. ,;s§14. .k 14Z'. •4-Gi .,n• YEAR NAME OF EMPLOYER NAME OF SUPERVISO' TELEPHONE NUMBER FROM TO 1 �._. I14{Z r, '.- ._ ... . 0% SO- FI r 60 I ti Form 3c Page 2 .table Form 3c 0900016458 . 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. ignature of Manageriv:// t 1114.1SignaeRature21141Y(jf Spouse State of Nebraska . County of Dou91( S County of bot& 1A.S The foregoing instrument was acknowledged before The foregoing instrument was acknowledged before me this J(A,Ytt i 6‘ by me this &h t , 6i by 1 n . Vt *1-1ilotary Public signature .Not Public signature Affix Seal Here — sip—IlE M PLOW 6 s SNOW* gU al Fume. f Nary OIIIMw w Ime Mien Wawa 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 Page 4 :'',Ir• ., -.„ , ,.. , - 411.4* 1 Form 3c Page 2 .:?Cx..::��� .�ri "s�.;.i. ..:...": CITY&STATE YEAR YEAR - FROM TO FROM TO a .fir... 1 . , 1 _1,• i u. tilt . I�W_: --- - - - - - im. ,�.,fi�tt+� r•' .T�y' '--I .yam, s M_- r a�. » -r, sIPte,.j3 y ^ 3h''.ik%x, .i^.s.i..: - :zra:. .. . . ,9'9�' •k's_ d.n-.•. .. •341, a—. •c.......- ,.......• ,..6.1.. ,;s§14. .k 14Z'. •4-Gi .,n• YEAR NAME OF EMPLOYER NAME OF SUPERVISO' TELEPHONE NUMBER FROM TO 1 �._. I14{Z r, '.- ._ ... . 0% SO- FI r 60 I ti Form 3c Page 2 .table Form 3c 0900016458 . . OM p ti . City ® ®rnah a . Webras&a `� 1siaI''cp II k 1819 Farnam —Suite LC 1 2 � ``�:� rt lM. `6,'® a co Omaha, Nebraska 68183-0112 .� —��. . ;.� Buster Brown (402) 444-5550 City Clerk FAX (402) 444-5263 ° 94.D F�aR`���� September 8, 2009 Paxton Chop House, LLC Application to appoint James J. Dba"801 Chop House" Nelson manager of your present 1403 Farnam Street Class "C" Liquor License Omaha, NE 68102 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 September 22, 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 yours, 4; :::m Buster Brown City Clerk . BJB:clj trument was acknowledged before me this J(A,Ytt i 6‘ by me this &h t , 6i by 1 n . Vt *1-1ilotary Public signature .Not Public signature Affix Seal Here — sip—IlE M PLOW 6 s SNOW* gU al Fume. f Nary OIIIMw w Ime Mien Wawa 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 Page 4 :'',Ir• ., -.„ , ,.. , - 411.4* 1 Form 3c Page 2 .:?Cx..::��� .�ri "s�.;.i. ..:...": CITY&STATE YEAR YEAR - FROM TO FROM TO a .fir... 1 . , 1 _1,• i u. tilt . I�W_: --- - - - - - im. ,�.,fi�tt+� r•' .T�y' '--I .yam, s M_- r a�. » -r, sIPte,.j3 y ^ 3h''.ik%x, .i^.s.i..: - :zra:. .. . . ,9'9�' •k's_ d.n-.•. .. •341, a—. •c.......- ,.......• ,..6.1.. ,;s§14. .k 14Z'. •4-Gi .,n• YEAR NAME OF EMPLOYER NAME OF SUPERVISO' TELEPHONE NUMBER FROM TO 1 �._. I14{Z r, '.- ._ ... . 0% SO- FI r 60 I ti Form 3c Page 2 .table Form 3c 0900016458 . • . Cityof Omaha, 57sfthrasg 1819 Farnam — Suite LC 1 2 .1r craverri ,1411, , „.„„in 1819 Omaha, Nebraska 68183-0112 o� � "'W Buster Brown (402) 444-5550 City Clerk FAX (402) 444-5263 0' Q D FEB��P�A September 8, 2009 James J. Nelson Application to be appointed manager of the present 1024 Dodge Street#502 Class "C" Liquor License for Paxton Chop House, LLC, Omaha,NE 68102 dba"801 Chop House", 1403 Farnam 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 September 22, 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, VV Buster Brown City Clerk BJB:clj Clerk . BJB:clj trument was acknowledged before me this J(A,Ytt i 6‘ by me this &h t , 6i by 1 n . Vt *1-1ilotary Public signature .Not Public signature Affix Seal Here — sip—IlE M PLOW 6 s SNOW* gU al Fume. f Nary OIIIMw w Ime Mien Wawa 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 Page 4 :'',Ir• ., -.„ , ,.. , - 411.4* 1 Form 3c Page 2 .:?Cx..::��� .�ri "s�.;.i. ..:...": CITY&STATE YEAR YEAR - FROM TO FROM TO a .fir... 1 . , 1 _1,• i u. tilt . I�W_: --- - - - - - im. ,�.,fi�tt+� r•' .T�y' '--I .yam, s M_- r a�. » -r, sIPte,.j3 y ^ 3h''.ik%x, .i^.s.i..: - :zra:. .. . . ,9'9�' •k's_ d.n-.•. .. •341, a—. •c.......- ,.......• ,..6.1.. ,;s§14. .k 14Z'. •4-Gi .,n• YEAR NAME OF EMPLOYER NAME OF SUPERVISO' TELEPHONE NUMBER FROM TO 1 �._. 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