RES 2009-0806 - Appoint Doris J Parker manager of Target Store T-2125 •
4,t. ST9'AN
44
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y °ti RFCFIVEC�
`w" `�` STATE OF NEBRASKA
Dave Heineman NEBRASKA LIQUOR CONTROL COMMISSION
''4��''' i; AV'A Governor /� JULHobert B. Rupe
4p n,'•••.' 6�,_` 09 J —6J 8: 4 1 Executive Director
crcr"R`s 301 Centennial Mall South,5th Floor
P.O.Box 95046
CITY CLERK Lincoln,Nebraska 68509-5046
OMAHA, r�`C4YY Phone(402)471-2571
July 2, 2009Fax(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: STL OF NEBRASKA INC
DBA: TARGET STORE T-2125
LICENSE #DK 75370
Dear Clerk:
Enclosed is a copy of a manager application for Doris J Parker in connection with Target Store T-2125,
located at 7200 Dodge Street in Omaha, 68144.
Please present this application for manager to your City/Village Council or County Commissioners and
send us the results of their action.
Sincerely,
4WD
Lynn umake
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
1
County of3 KEGS
The foregoing_instrument wakacknowledged before The fore ing instrument was aektowledged before
me this(Lu if r cacjoti by me this(jUr1(.—act 6 by iI
S g ` Jai P5g1 611
Notary Public signature Notary Public signature
Affix Seal Aix Sal Has
SYACI J.KUHL
jei STAG J.KUNL + State of Nebroska•Gene>g1 Notary
State of Nebresks•Genersi Notary My Commlasion Expires
My Commission Expires esimetiopternt>�12.2011
Septetnbe 12.20t i
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.
Revbed9/2068
� I
Form 3c Page 4
YEAR
FROM TO FROM TO
ort Calhoun,NE[
11994 009 ort Calhoun,NE
1994 009
1 INN NMI 111111
IIIIII 11111 Mil
*.' :414* c. .-.,- .- 1 ,--i_..r--: --ii .. .. s-- - ,:,, , : „,, ,-.,i..-, ,,.., :, -&,_. y . ,,- . Li i'i Ake14,11,, 4,, , if • .I.4 ui 4-4 il.n. ir....iik.,.•-wthq
n4Met ....ft.41 I I t q 10 e f"Lir'-. . AV-AV „ , ,414 r1111-1
YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER
FROM TO
1980 e Stamp Collection Eileen E.Stamp-Owner losed
,`7'''.*, ., L,- '413 lik.**,i -- .-*ti.tre=*', .14ii '. .444i, ;',-r''*-4-_,Ir .4ii.,-;fc..4,1;,4- --*-_,g., ,2 t.--,11- r .,i- # .4-,-..,:4".I.,:, '•:,. .-..-_,.„' _
Form 3c Page 2
o come.
City Council Members:
District 1: Pete Festersen: 402-444-5527 District 5: Jean Stothert: 402-444-5528
District 2: Ben Gray: 402-444-5524 District 6: Franklin Thompson: (402)444-5523
District 3: Chris Jerram: 402-444-5525 District 7: Chuck Sigerson,Jr. 402)444-5526
District 4: Garry Gernandt: (402)444-5522
To send email: Contacts Links: http://co.douglas.ne.us/omaha/citycouncil/council-members
ual capital improvements,and various lease-purchase agreements are financed by the General Fund.
MANAGER APPLICATION Office Use
INSERT-FORM 3c C �+
NEBRASKA LIQUOR CONTROL COMMISSION R 4.C I V E D
301 CENTENNIAL MALL SOUTH
PO BOX 95046
LINCOLN,NE 68509-5046 JUN 2 92009
PHONE:(402)471-2571
FAX:(402)471-2814 •
Website:www.Icc.ne.gov
NEBRASKA LIOUOR
CONTROI 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
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
Name of Corporation/LLC: STt.. 4•P 1\it bra51/41.
Premise License Number: b� 'J 3`70
(if new application leave blank)
Premise Trade Name/DBA: T&r p f- .1/49-Dre, 1 -Al 9.5
Premise Street Address: 19100 body 6--
City: omoiho. Zip Code: 44114
Premise Phone Number: 140-310-888O
`3Q., •
CORPORATE OFFICER SIGNATURE
Faxed si: 'atures are acce stable
•
Form 3c ---
0900012080
ty/Affirmative Action Employer
Printed with soy ink on recycled paper
1
County of3 KEGS
The foregoing_instrument wakacknowledged before The fore ing instrument was aektowledged before
me this(Lu if r cacjoti by me this(jUr1(.—act 6 by iI
S g ` Jai P5g1 611
Notary Public signature Notary Public signature
Affix Seal Aix Sal Has
SYACI J.KUHL
jei STAG J.KUNL + State of Nebroska•Gene>g1 Notary
State of Nebresks•Genersi Notary My Commlasion Expires
My Commission Expires esimetiopternt>�12.2011
Septetnbe 12.20t i
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.
Revbed9/2068
� I
Form 3c Page 4
YEAR
FROM TO FROM TO
ort Calhoun,NE[
11994 009 ort Calhoun,NE
1994 009
1 INN NMI 111111
IIIIII 11111 Mil
*.' :414* c. .-.,- .- 1 ,--i_..r--: --ii .. .. s-- - ,:,, , : „,, ,-.,i..-, ,,.., :, -&,_. y . ,,- . Li i'i Ake14,11,, 4,, , if • .I.4 ui 4-4 il.n. ir....iik.,.•-wthq
n4Met ....ft.41 I I t q 10 e f"Lir'-. . AV-AV „ , ,414 r1111-1
YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER
FROM TO
1980 e Stamp Collection Eileen E.Stamp-Owner losed
,`7'''.*, ., L,- '413 lik.**,i -- .-*ti.tre=*', .14ii '. .444i, ;',-r''*-4-_,Ir .4ii.,-;fc..4,1;,4- --*-_,g., ,2 t.--,11- r .,i- # .4-,-..,:4".I.,:, '•:,. .-..-_,.„' _
Form 3c Page 2
o come.
City Council Members:
District 1: Pete Festersen: 402-444-5527 District 5: Jean Stothert: 402-444-5528
District 2: Ben Gray: 402-444-5524 District 6: Franklin Thompson: (402)444-5523
District 3: Chris Jerram: 402-444-5525 District 7: Chuck Sigerson,Jr. 402)444-5526
District 4: Garry Gernandt: (402)444-5522
To send email: Contacts Links: http://co.douglas.ne.us/omaha/citycouncil/council-members
ual capital improvements,and various lease-purchase agreements are financed by the General Fund.
Gender: ❑ MALE ►i FEMALE
Last Name: • 170,..r K pX' First Name: b7ris MI: j'
Home Address(include PO Box if applicable): iplap (Cyp. - Lane,
City: LLL\J�S-FtNJ State: N,E Zip Code: (Q 8 I a8
Home Phone Number: WA- 5611-QI uo Business Phone Number: £-baZ-36)0~8ei0
Social Security Number_ Drivers License Number& State: NE.
Date Of Birth: Place Of Birth: oSloLL Li` y T
DYES 4gNO
Spouses Last Name: First Name: MI:
Social Security Number: Drivers License Number& State:
Date Of Birth: Place Of Birth:
CITY&STATE YEAR CITY&STATE YEAR
FROM TO FROM TO
tIPM ma_
YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER
FROM TO
Pc n .i .. • ..4 = II, - •a- 28go
Form 3c Page 2
a
11
1. READ PARAGRAPH CAREFULLY AND ANSWER COMPLETELX OMM IP ON.
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.
EYES FrNO 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.
EYES ONO
3. Do you, as a manager,have all the qualifications required to hold a Nebraska quor License? Nebraska
Liquor Control Act(§53-131.01)
j: rsIES 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 for$38.00 per p mQn) _
OYES []NO :r1 ..,.
5. Do you have any experience in selling alcohol in the State of Nebraska? AIO
If so list training and/or experience(when and where)
Date: Where:
• 1
Form 3c Page 3
1
County of3 KEGS
The foregoing_instrument wakacknowledged before The fore ing instrument was aektowledged before
me this(Lu if r cacjoti by me this(jUr1(.—act 6 by iI
S g ` Jai P5g1 611
Notary Public signature Notary Public signature
Affix Seal Aix Sal Has
SYACI J.KUHL
jei STAG J.KUNL + State of Nebroska•Gene>g1 Notary
State of Nebresks•Genersi Notary My Commlasion Expires
My Commission Expires esimetiopternt>�12.2011
Septetnbe 12.20t i
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.
Revbed9/2068
� I
Form 3c Page 4
YEAR
FROM TO FROM TO
ort Calhoun,NE[
11994 009 ort Calhoun,NE
1994 009
1 INN NMI 111111
IIIIII 11111 Mil
*.' :414* c. .-.,- .- 1 ,--i_..r--: --ii .. .. s-- - ,:,, , : „,, ,-.,i..-, ,,.., :, -&,_. y . ,,- . Li i'i Ake14,11,, 4,, , if • .I.4 ui 4-4 il.n. ir....iik.,.•-wthq
n4Met ....ft.41 I I t q 10 e f"Lir'-. . AV-AV „ , ,414 r1111-1
YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER
FROM TO
1980 e Stamp Collection Eileen E.Stamp-Owner losed
,`7'''.*, ., L,- '413 lik.**,i -- .-*ti.tre=*', .14ii '. .444i, ;',-r''*-4-_,Ir .4ii.,-;fc..4,1;,4- --*-_,g., ,2 t.--,11- r .,i- # .4-,-..,:4".I.,:, '•:,. .-..-_,.„' _
Form 3c Page 2
o come.
City Council Members:
District 1: Pete Festersen: 402-444-5527 District 5: Jean Stothert: 402-444-5528
District 2: Ben Gray: 402-444-5524 District 6: Franklin Thompson: (402)444-5523
District 3: Chris Jerram: 402-444-5525 District 7: Chuck Sigerson,Jr. 402)444-5526
District 4: Garry Gernandt: (402)444-5522
To send email: Contacts Links: http://co.douglas.ne.us/omaha/citycouncil/council-members
ual capital improvements,and various lease-purchase agreements are financed by the General Fund.
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.
Sig re of Manager Applicant Signature of Spouse
State of Nebraska
County of —Do a--5 County of
The foregoing instrument was acknowledged before The foregoing instrument was acknowledged before
me this,,...964 — m 0 by ' me this by
Notary
lic si nature Public si nature
S Notary g
Affix S Affix Seal Here
GENERAL NOTARY,State of Nebraska
PATRICIA J.TYLER
My Comm.Exp,I*.21.2012
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 9/2008
Form 3c Page 4
1
My Commission Expires esimetiopternt>�12.2011
Septetnbe 12.20t i
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.
Revbed9/2068
� I
Form 3c Page 4
YEAR
FROM TO FROM TO
ort Calhoun,NE[
11994 009 ort Calhoun,NE
1994 009
1 INN NMI 111111
IIIIII 11111 Mil
*.' :414* c. .-.,- .- 1 ,--i_..r--: --ii .. .. s-- - ,:,, , : „,, ,-.,i..-, ,,.., :, -&,_. y . ,,- . Li i'i Ake14,11,, 4,, , if • .I.4 ui 4-4 il.n. ir....iik.,.•-wthq
n4Met ....ft.41 I I t q 10 e f"Lir'-. . AV-AV „ , ,414 r1111-1
YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER
FROM TO
1980 e Stamp Collection Eileen E.Stamp-Owner losed
,`7'''.*, ., L,- '413 lik.**,i -- .-*ti.tre=*', .14ii '. .444i, ;',-r''*-4-_,Ir .4ii.,-;fc..4,1;,4- --*-_,g., ,2 t.--,11- r .,i- # .4-,-..,:4".I.,:, '•:,. .-..-_,.„' _
Form 3c Page 2
o come.
City Council Members:
District 1: Pete Festersen: 402-444-5527 District 5: Jean Stothert: 402-444-5528
District 2: Ben Gray: 402-444-5524 District 6: Franklin Thompson: (402)444-5523
District 3: Chris Jerram: 402-444-5525 District 7: Chuck Sigerson,Jr. 402)444-5526
District 4: Garry Gernandt: (402)444-5522
To send email: Contacts Links: http://co.douglas.ne.us/omaha/citycouncil/council-members
ual capital improvements,and various lease-purchase agreements are financed by the General Fund.
OM"4'
City of Omaha, Webras&a ` �11
1819 Farnam—Suite LC 1 ® f/• r�� 4 d
Omaha, Nebraska 68183-0112 0�.::-- '• �'
Buster Brown (402) 444-5550
City Clerk FAX (402) 444-5263 04)'�ED FEBR��I.
July 14, 2009
STL of Nebraska, Inc. Application to appoint Doris J. Parker
Dba"Target Store T-2125" manager of your present Package &
7200 Dodge Street Catering 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 July 28, 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
wledged before The foregoing instrument was acknowledged before
me this,,...964 — m 0 by ' me this by
Notary
lic si nature Public si nature
S Notary g
Affix S Affix Seal Here
GENERAL NOTARY,State of Nebraska
PATRICIA J.TYLER
My Comm.Exp,I*.21.2012
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 9/2008
Form 3c Page 4
1
My Commission Expires esimetiopternt>�12.2011
Septetnbe 12.20t i
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.
Revbed9/2068
� I
Form 3c Page 4
YEAR
FROM TO FROM TO
ort Calhoun,NE[
11994 009 ort Calhoun,NE
1994 009
1 INN NMI 111111
IIIIII 11111 Mil
*.' :414* c. .-.,- .- 1 ,--i_..r--: --ii .. .. s-- - ,:,, , : „,, ,-.,i..-, ,,.., :, -&,_. y . ,,- . Li i'i Ake14,11,, 4,, , if • .I.4 ui 4-4 il.n. ir....iik.,.•-wthq
n4Met ....ft.41 I I t q 10 e f"Lir'-. . AV-AV „ , ,414 r1111-1
YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER
FROM TO
1980 e Stamp Collection Eileen E.Stamp-Owner losed
,`7'''.*, ., L,- '413 lik.**,i -- .-*ti.tre=*', .14ii '. .444i, ;',-r''*-4-_,Ir .4ii.,-;fc..4,1;,4- --*-_,g., ,2 t.--,11- r .,i- # .4-,-..,:4".I.,:, '•:,. .-..-_,.„' _
Form 3c Page 2
o come.
City Council Members:
District 1: Pete Festersen: 402-444-5527 District 5: Jean Stothert: 402-444-5528
District 2: Ben Gray: 402-444-5524 District 6: Franklin Thompson: (402)444-5523
District 3: Chris Jerram: 402-444-5525 District 7: Chuck Sigerson,Jr. 402)444-5526
District 4: Garry Gernandt: (402)444-5522
To send email: Contacts Links: http://co.douglas.ne.us/omaha/citycouncil/council-members
ual capital improvements,and various lease-purchase agreements are financed by the General Fund.
li
OMx"' Ark,
Cityof Omaha, fAlebras&a 4psi
ti, •
d
�r_
• 1819 Farnam— Suite LC 1 r �
Omaha, Nebraska 68183-0112 0�
Buster Brown (402) 444-5550o
City Clerk FAX (402) 444-5263 Zle i v�.4�
Fp FEBR
July 14, 2009
Doris J. Parker Application to be appointed manager of the present
6706 Hillcrest Lane Package & Catering Liquor License for STL of
La Vista,NE 68128 Nebraska, Inc., dba"Target Store T-2125", 7200 Dodge
Dear Liquor License Manager Applicant:
This letter is notification that a hearing before the Omaha City Council on your
application fo be appointed manager of the liquor license has been set for July 281
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
this by
Notary
lic si nature Public si nature
S Notary g
Affix S Affix Seal Here
GENERAL NOTARY,State of Nebraska
PATRICIA J.TYLER
My Comm.Exp,I*.21.2012
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 9/2008
Form 3c Page 4
1
My Commission Expires esimetiopternt>�12.2011
Septetnbe 12.20t i
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.
Revbed9/2068
� I
Form 3c Page 4
YEAR
FROM TO FROM TO
ort Calhoun,NE[
11994 009 ort Calhoun,NE
1994 009
1 INN NMI 111111
IIIIII 11111 Mil
*.' :414* c. .-.,- .- 1 ,--i_..r--: --ii .. .. s-- - ,:,, , : „,, ,-.,i..-, ,,.., :, -&,_. y . ,,- . Li i'i Ake14,11,, 4,, , if • .I.4 ui 4-4 il.n. ir....iik.,.•-wthq
n4Met ....ft.41 I I t q 10 e f"Lir'-. . AV-AV „ , ,414 r1111-1
YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER
FROM TO
1980 e Stamp Collection Eileen E.Stamp-Owner losed
,`7'''.*, ., L,- '413 lik.**,i -- .-*ti.tre=*', .14ii '. .444i, ;',-r''*-4-_,Ir .4ii.,-;fc..4,1;,4- --*-_,g., ,2 t.--,11- r .,i- # .4-,-..,:4".I.,:, '•:,. .-..-_,.„' _
Form 3c Page 2
o come.
City Council Members:
District 1: Pete Festersen: 402-444-5527 District 5: Jean Stothert: 402-444-5528
District 2: Ben Gray: 402-444-5524 District 6: Franklin Thompson: (402)444-5523
District 3: Chris Jerram: 402-444-5525 District 7: Chuck Sigerson,Jr. 402)444-5526
District 4: Garry Gernandt: (402)444-5522
To send email: Contacts Links: http://co.douglas.ne.us/omaha/citycouncil/council-members
ual capital improvements,and various lease-purchase agreements are financed by the General Fund.
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Of Birth: oSloLL Li` y T
DYES 4gNO
Spouses Last Name: First Name: MI:
Social Security Number: Drivers License Number& State:
Date Of Birth: Place Of Birth:
CITY&STATE YEAR CITY&STATE YEAR
FROM TO FROM TO
tIPM ma_
YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER
FROM TO
Pc n .i .. • ..4 = II, - •a- 28go
Form 3c Page 2