RES 2009-0658 - Appoint Travis J Saint manager of Red Robin America's Gourmet Burgers & Spirits _—�SHE`S T9"1`111
, � '�`���''�- RECEIVED STATE OF NEBRASKA
0,
p ''' NEBRASKA LIQUOR CONTROL COMMISSION
9�x ;.�.;,�� Dave Heinem ff�'��`� Q
�' ;i.. _ % Governor J U -4 �: Hobert B. Rupe
ii Executive Director
t1� 301 Centennial Mall South,5th Floor
CITY CLrRK P.O. Box 95046
Lincoln,Nebraska 68509-5046
OMAHA, NEt RASISI, Phone(402)471-2571
June 2, 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: RED ROBIN INTERNATIONAL, INC
DBA: RED ROBIN AMERICA'S GOURMET BURGERS & SPIRITS
LICENSE #I 57559
Dear Clerk:
Enclosed is a copy of a manager application for Travis J Saint in connection with Red Robin America's
Gourmet Burgers and Spirits, located at 2627 S 180 Street in Omaha, 68130.
Please present this application for manager to your City/Village Council or County
Commissioners and send us the results of their action.
Sincerely,
•
1 1
Lynn ake
Licensing Division
NEBRASKA LIQUOR CONTROL COMMISSION
encl.
cc: file
Rhonda R.Flower Bob Logsdon Robert Batt
Commissioner Chairman Commissoner
An Equal Opportunity/Affirmative Action Employer
{� Printed with soy ink on recycled paper
ledged before
me this ore' "`d__ Q f y by me this 9l /i1,7 74A99 by .• •
Met . 4. '
Notary Publl ignature • Notary Pubii ignature
•
Affix Seal He Affix Sear Here
di GENERAL NOTARYM• Nebraska • .
MON NOHNER WENERAL NOTARY•Stete of Nebraska
My Comte.Exp.May 31,2010 1MIGUEi C NUNO •
MI Comm.Exp.April 10,2012
•
•
In compliance with the ADA,this manager insert form 3c•is available in other formats for persona with disabilities.
A ten day advance period is required in writing to produce the alternate format.
Revised 9/2008
•
Form 3c ' Page 4
MANAGER APPLICATION Office Use .
. .
nvSER -FORM 3c RECEIVED • . •
•
NEBRASKA LIQUOR CONTROL COMMISSION
301•CENTENNIAL MALL SOUTH •
•
PO sox 95046 • MAY 18 2009 . .
LINCOLN,NE 68509-5046
PHONE:(402)471-2571 •
FAXWebs(4te:2)w w.c2s14 NEBRASKA LIQUOR
Website:www.IcC.ne.gpv
• • CONTROL COMMISSION .
Corporate manager,including spouse,are required to adhere to the following requirements 1"
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•certifiicate,naturalization paper or US passportV) • .
•
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: RQ d (2 C t rr lrike.Y V1.0 i YrG , \ c• •
•
Premise License Number: .i -51 j5q
(if new application leave blank) •
.
Premise TradeName/DBA: Rec Bola n Avykvicds ZA OW-y net nu..Y CAMS-4-.S0.1i{-s .
Premise Street Address: Mai cj _ t 80}h . .
City: OICY1 _. - c3 . Zip Code; V)$k 0
•
•
Premise Phone Number: 4-0 ? 2120 _ O k.4 0.0 .
I
ilg--4IT/
CORPORAT OFFICER SIGNATURE
Faxed signatures are acce table
•
0900010345
Form 3c
•
Affix Seal He Affix Sear Here
di GENERAL NOTARYM• Nebraska • .
MON NOHNER WENERAL NOTARY•Stete of Nebraska
My Comte.Exp.May 31,2010 1MIGUEi C NUNO •
MI Comm.Exp.April 10,2012
•
•
In compliance with the ADA,this manager insert form 3c•is available in other formats for persona with disabilities.
A ten day advance period is required in writing to produce the alternate format.
Revised 9/2008
•
Form 3c ' Page 4
Gender. 0 MALE : r ■ FEMALE
Last Name: 5 61 n.-k First Name: TraV 3 MI: Z.
Home Ac iess`�ii-fc'litdd PO;, AoI if applicable): 2( Z..'7 Neut.i n l t14 Li ca,cf E-
City: OW14 i\R•• State: me. Zip Code: tQ$1((Q
Home Phone Numbe c/p2,) (p 14--2'/33 Business Phone Number:(o'L) 330 - 4 to ND
Social Security Number:. ;Qj Drivers License Number& State: ,o ME
Date Of Birth: _ _ _ Place Of Birth: �f- (A)oQtt , I
[EYES ❑NO
Spouses Last Name: S Al 04- First Name: R..-E 6e.CCA MI: Ki
Social Security Number:_ Drivers License Number&State: . . ,r_„_ _ u6
Date Of Birth: , ..._ - - - ;► Place Of Birth: E 40)-1+
CITY&STATE YEAR CITY&STATE YEAR
FROM TO FROM TO
i ��: , Zszor NW 0,, :.. - . 0- P A .-A.
..:_ : .. I MM Foams (Jo Mil Zoos•
s
zooc. _ . PA 4 s 4 L oo i oo2,
111W11.1111111111111.1111111 .�xa.y zoo
YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER
FROM TO '
IIZOOS '-*Er O ICI . , ' �� %ors r�
ZooD ZOOS 1 1
tirgENVI
Form 3c Page 2
{-s .
Premise Street Address: Mai cj _ t 80}h . .
City: OICY1 _. - c3 . Zip Code; V)$k 0
•
•
Premise Phone Number: 4-0 ? 2120 _ O k.4 0.0 .
I
ilg--4IT/
CORPORAT OFFICER SIGNATURE
Faxed signatures are acce table
•
0900010345
Form 3c
•
Affix Seal He Affix Sear Here
di GENERAL NOTARYM• Nebraska • .
MON NOHNER WENERAL NOTARY•Stete of Nebraska
My Comte.Exp.May 31,2010 1MIGUEi C NUNO •
MI Comm.Exp.April 10,2012
•
•
In compliance with the ADA,this manager insert form 3c•is available in other formats for persona with disabilities.
A ten day advance period is required in writing to produce the alternate format.
Revised 9/2008
•
Form 3c ' Page 4
MAY 18 2009
1. READ PARAGRAPH CAREFULLY AND ANSWER COMPLETELY ANDO ELY.
7RO�LIQUOR
Has anyone who is a party to this application,or their spouse, EVER been 4onvicted of or pTea� ON
to any charge. Charge means any charge alleging a felony,misdemeanor,4iolation 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 indvidual's name.
[RYES ENO If yes,please explain below or attach a separate page.
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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.
EYES [210
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 fmgerprint 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)
. Y ..yr ,...'._�.,._.,,.b---_,.,, oJ,,:::{1 41's-;.VQF.",3I1,stig3 D A
Ocrts
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:
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Form 3c
Page 3
in writing to produce the alternate format.
Revised 9/2008
•
Form 3c ' Page 4
The above individtial(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 stateiierits contained therein are true. If any.false statement is made in any part of this application;the applicant(s) shall be
• deemt3 fI.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. .
C2reofMent . • Signature of Spo se
State of Nebraska •
County of kJ t,o yis c County of a i,AS
The for4t.
• g instrument was acknowledged before The.foregoing.instrument was acknowledged before
• me this 13 2Ob q • by • . me this ": I aDG1 by:f
•
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tary Pabl ignature o4iitite.g. ' 7.:)(//1•641,0t_. .
tary Publics afore
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' Affix Seal Here . . . - • . Affix Seal Here
• Ml fl • •i URA OXON-Slab IS Neaps • [ MELMI{E MIJEU. R .
. F thaw: No • IMO •1ty Conn.60.Nov.6.2010
n compliance with the ADA,this manager insert form 3c is available in other formats for persons with disabilities.
i . •
. Alen day advance period is required in writing to produce the alternate format,
. • Revised 9/2008
•
►—.� ... '. .. •
... .
• Form 3c Page 4
SPOUSAL AleFIDAVIT OF • ofrreeuse 1 V 'I.
NON PARTICIPATION INSERT •
NEBRASKA LIQUOR CONTROL COMMISSION ( MAY 18 2009
301 CENTENNIAL MALL SOUTH
PO BOX 9so46 NEBRAS,( LIQUOR
LINCOLN.NE 68504-5046
PHONE:(402)471-2571 CONTROL COMMISSI tl N FAX:(402)471-2814 j
Website: www,Ice.rto.gov
i
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♦
42 .
ignature of spouse asking or waiver Printed name of sp.use asking for waiver
(Spouse of individual listed below)
State of
0 6 k�ks4- . i
County of -c)c tA$ The foregoing instrumen,was acknowledged before me this •
9int
by 1ebe c Ca
namrson acknowledged
♦ AI ji; :;ffix Seal 1
Mai. ,S11811191101811111
Notary Public signature MUE.1.
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Sign. e of individual involved with application . Printed name of a►plying individual
• (Spouse of individual listed above) - i •
State of i E10�,a4rck,. ,
County of The foregoinginstrument was acknowledgedme this
c before
•
c2t� 0! Tat/o Aft/ cl�9 by I vi S c. i/1+.
•
« r name of person a?knowledged
•
n_ Affix Seal
f / .gitisGfam.NOTARY-Stet of Nebraska_ '
APotary Public signs re ) LORI MILES
C0 ThIt Eq.W. O.tote.
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. 1 •
• FORM 35-4178
Revised 1/2008
•
pMAHA,
Cityof OmahaWebras&a � N
�I "1
Mirifir
ri
1819 Farnam — Suite LC 1 2' 1E,r `AI
Omaha, Nebraska 68183-0112 0i'.=, ;.� :,
Buster Brown (402) 444-5550
o
City Clerk FAX (402) 444-5263 4491'Fp FEl5A Is+
June 9, 2009
Red Robin International, Inc. Application to appoint Travis J. Saint
Dba"Red Robin America's manager of your present Class"I"
Gourmet Burgers & Spirits" Liquor License
2627 South 180th Street
Omaha,NE 68130
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 June 23, 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,
,,e4IF
Buster Brown
City Clerk
BJB:clj
.4.44, 1
♦
42 .
ignature of spouse asking or waiver Printed name of sp.use asking for waiver
(Spouse of individual listed below)
State of
0 6 k�ks4- . i
County of -c)c tA$ The foregoing instrumen,was acknowledged before me this •
9int
by 1ebe c Ca
namrson acknowledged
♦ AI ji; :;ffix Seal 1
Mai. ,S11811191101811111
Notary Public signature MUE.1.
- al*se.lra-it,
- l ,i � T" .„. cz �_C s' r^e � �'"; yY r„aa t- Sv8 i i.a v e: L c�Fr.ua �i:i`ti-"1 ,.,,p.•4:i+ :Ei�i •,:l.,k$-'c-
�7n i
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1 r t8,vt69''`?• ':1:la T. `R•4;,UA. cl+Mk^& '4!: * jY '"` A."' e ''� +'i �:� . S a�' 3r' . _ r
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• I
r►„
j1A _ j ; _... _ ./s !A-i t---
Sign. e of individual involved with application . Printed name of a►plying individual
• (Spouse of individual listed above) - i •
State of i E10�,a4rck,. ,
County of The foregoinginstrument was acknowledgedme this
c before
•
c2t� 0! Tat/o Aft/ cl�9 by I vi S c. i/1+.
•
« r name of person a?knowledged
•
n_ Affix Seal
f / .gitisGfam.NOTARY-Stet of Nebraska_ '
APotary Public signs re ) LORI MILES
C0 ThIt Eq.W. O.tote.
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. 1 •
• FORM 35-4178
Revised 1/2008
•
�MAHA N
O� il'I ;r pep
City ofOmaha fAfebraskg '
kozi
1819 Farnam Suite LC 1 0,adrycfi- ''
`:�1� _
Omaha, Nebraska 68183-0112 o a ''
Buster Brown (402) 444-5550
City Clerk FAX (402) 444-5263 o4) FEBR�t►it-
June 9, 2009
Travis J. Saint Applications to be appointed manager of the present
2127 North 167th Circle Class "I" Liquor Licenses for Red Robin International, Inc.,
Omaha,NE 68116 dba"Red Robin America's Gourmet Burgers & Spirits",
2627 South 180th 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 June 23,
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
Buster Brown
City Clerk
BJB:clj
♦
42 .
ignature of spouse asking or waiver Printed name of sp.use asking for waiver
(Spouse of individual listed below)
State of
0 6 k�ks4- . i
County of -c)c tA$ The foregoing instrumen,was acknowledged before me this •
9int
by 1ebe c Ca
namrson acknowledged
♦ AI ji; :;ffix Seal 1
Mai. ,S11811191101811111
Notary Public signature MUE.1.
- al*se.lra-it,
- l ,i � T" .„. cz �_C s' r^e � �'"; yY r„aa t- Sv8 i i.a v e: L c�Fr.ua �i:i`ti-"1 ,.,,p.•4:i+ :Ei�i •,:l.,k$-'c-
�7n i
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.,, s --, '` .- , � tirE ip.r j 1� s3 .r.a .. '`i � -r"" e ., ,sv,k :,S`irr�,o. esri , epu.E" '
e_ c4 ere r a' 1 ?r r t ti ri c fir..",„ ; .i S":-,,', 3 .�� i“.: T a s .
1 r t8,vt69''`?• ':1:la T. `R•4;,UA. cl+Mk^& '4!: * jY '"` A."' e ''� +'i �:� . S a�' 3r' . _ r
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• I
r►„
j1A _ j ; _... _ ./s !A-i t---
Sign. e of individual involved with application . Printed name of a►plying individual
• (Spouse of individual listed above) - i •
State of i E10�,a4rck,. ,
County of The foregoinginstrument was acknowledgedme this
c before
•
c2t� 0! Tat/o Aft/ cl�9 by I vi S c. i/1+.
•
« r name of person a?knowledged
•
n_ Affix Seal
f / .gitisGfam.NOTARY-Stet of Nebraska_ '
APotary Public signs re ) LORI MILES
C0 ThIt Eq.W. O.tote.
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. 1 •
• FORM 35-4178
Revised 1/2008
•
•
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Social Security Number: _Drivers License Number&State;
Date Of Birth: _ Place Of Birth: 1 " w
CITY&STATE YEAR CITY&STATE YEAR
FROM TO FROM TO
lei D . Kt, 'Oq M
11111111
YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER
FROM TO
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Form 3c Page 2