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RES 2009-0808 - SDL for Italian festival at Roncalli Catholic High School September4-6 2009 Print Form • APPLICATION FOR SPECIAL DESIGNATED LICENSE NON PROFIT APPLICANTS NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH PO BOX 95046 LINCOLN,NE 68509-5046 PHONE:(402)471-2571 FAX(402)471-2814 Website:www.lcc.nc.gov/ BEFORE SUBMITTING APPLICATION TO THE LIQUOR CONTROL COMMISSION fl Include approval from the City,Village or County Clerk where the event is to be held Include signed statement from the local law enforcement(see question#8) ® A license fee$40(payable to Nebraska Liquor Control Commission)for each day/event to be licensed(i.e.if you have two separate areas at one event they both need to be licensed) D Application MUST be received at the Liquor Control Commission Office no later than 10 working days prior to event(excluding weekends,Federal and State observed holidays) Letter from IRS declaring your organization exempt from payment of federal income taxes,or copy of federal tax return,as filed with the IRS,as well as affidavit signed by an officer of the organization declaring that the copy of the tax return is true and correct copy as filed with the IRS COMPLETE ALL QUESTIONS 1. Type of alcohol to be served and/or consumed Beer le Wine $Distilled Spirits 2. Status of applicant(check one) ❑Municipal 0 Political CI Fine Arts C]Fratemal®Religious Charitable°Public Service 3. Licensee name(last,first,middle),Corporate name,Limited Liability Company(LLC) NAME: kir()l an -F?et( ' /4'ii7)e E i;Ell/ ADDRESS:/d bX 127I7i c22/dA4f C �h OUNTY Ae 272-7 Ay Comm Exp.July 17,2010 In compliance with the ADA,this manager insert form 3c is available m other formats for persons with disabilities. A ten day advance period is required in writing to produce the alternate format. . Revised 9/2008 A IL Form 3c Page 4 ommission 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. , • 4. Location where event will be hel •nam a addrgss ,co ty,zip code Ron cal/," C bethy ' ADDRESS: 44 a 15ore,35-e/� ,°k oh/ COUNTY v 1"1-5- , 'vg2a. Is this location within the city/village limits? /5 YES ONO b. Is this location within the 150'of church,school,hospital or home aged/indigent or for veterans their wives? 'OYES❑NO c. Is this location within 300' of any university or college campus? ®YESTO 5. Date(s)and Time(s)of event(no more then six(6)consecutive days on one application) Date! ci>4/C7A I Dail 4 /.J/foct P Date'c /Coto ci I Date I Datc j Date Hours From Hours From Hours From Hours From Hours From Hours From lirtir (hoa,.)if piTo) To/74Iy4 I Zpir► To12atot To To To a. Alternate date . b. Alternate location: (alternate date or location must be approved by local bind law 5 ent) 1�h,;�L 6. Indicate type of activity to be carried on during event VDince ©Receptioo n FundRai�er Beer Garden ESampling/Tasting Other k'O-f 'tF e $ ,447/.rsidn fS �'p -fic e'f pvoe A/ 7. It- 'ption of area to be licensed cio`x 'iJ ca err Ii�"" tic . ide building,dimensions of area to be covered INFEET 12.S x le, hO J C 1 Name of building (not square feet or acres) D Outdoor area dimensions of area to be covered INFEET V-1 a x i 5,4 (not square feet or acres) If outdoor area,how will re be encl ed IA fence,type of fence 5-44 e V' +r'4 c t ❑ tent El other,explain *If both inside and outdoor area to be licensed include simple sketch 8. Attach a signed statement from local police chief or county sheriff,whichever is applicable,that local law enforcement has been informed in lice of this event,and if they are aware of any reason the event should not occur. dA C- 9. Indicate the steps that will be taken to prevent underage persons from obtaining alcohol beverages. . ': .9. Will 4e c_ko,ckA l0. Will premises to be covered by license comply with all Nebraska sanitation laws? ,'g YES ❑NO a. Are there separate toilets for both men and women? 0 YES®NO 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. p 1-61 pocki.,1 r<o002d fit.ecf 'I OL D-;c)('s c,6e-ter wr �� 0°no• r x CD o C� td R' P. a 4, O x No n " . c e c mber& State: - t /ve Date Of Birth: Place Of Birth: OI'h11 ❑ YES igj NO Spouses Last Name: First Name: MI: Social Security Number: /r Drivers License Number& State: Date Of Birth: Place Of Birth: CITY&STATE YEAR CITY&STATE YEAR FROM TO FROM TO YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER FROM TO l°' Form 3c Page 2 = II, - •a- 28go Form 3c Page 2 July 2, 2009 To: Nebraska Liquor Control Commission Subject: Underage Access Control (Item 11,Nebraska Form 35-4121) We anticipate approximately 12,000 people will attend La Festa Italian over Labor Day weekend. All of our bartenders are trained to watch for underage persons attempting to buy alcohol. We have several bartenders at each bar so they are not rushed to sell products. We post signs that say we card anyone under 24 years old. In the event of doubt,we card! MI: Social Security Number: /r Drivers License Number& State: Date Of Birth: Place Of Birth: CITY&STATE YEAR CITY&STATE YEAR FROM TO FROM TO YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER FROM TO l°' Form 3c Page 2 = II, - •a- 28go Form 3c Page 2 11. Will there be any games of chance operating during the event? YES❑NO If so,describe activity "I(k/145 NOTE: Only games of chance approved by the Department of Revenue, Charitable Gaming Division are permitted. All other forms of gambling are prohibited by State Law: There are no exceptions for Non Profit Organizations or any events raising funds for a charity. This is only an application for a Special Designated License wider the Liquor Control Act and is not a gambling permit application. 12. Any other information or requests for exemptions: 13. Name and telephone number/cell phone number of immediate supervisor. This person will be at t the location of the event when it occurs, able to answer any questions from Commission and/or law enforcement before and during the event, and who will be responsible for ensuring that any applicable laws, ordinances,rules and regulations are adhered to. f T 11�2r Ctn i a i'ri r V. Phone: Before (PH - 1ci V 1 During i.n5) - 61-4-7) Print name of Event Supervisor 2/23q691Q7la EefiSi�ature of vt Supervisor' Consent of Authorized Representative/Applicant 14. I declare that I am the authorized representative of the above named license applicant and that the statements made on this application are true to the best of my knowledge and belief. I also consent to an investigation of my background including all records of every kind including police records. I agree to waive any rights or causes of action against the Nebraska Liquor Control Commission, the Nebraska State Patrol or any other individual releasing said information to the Liquor Control Commission or the Nebraska. State Patrol. I further declare that the license applied for will not be used by any other person, group, organization or corporation for profit or not for profit and that the event will be supervised by persons directly responsible to the holder of this Special Designated License. sign here � 74 h /l p � / ry Authorized epresentative/Applicant Title . Date Orli-1-z:4 Mo.VV U�� Print Name The law requires that no special designated license provided for by this section shall be issued by the Commission without the approval of the local governing body. For the purposes of this section,the local governing body shall be the city or village within which the particular place for which the special designated license is requested is located, or if such place is not within the. corporate limits of a city or village,then the local governing body shall be the county within which the place for which the special designated license is requested is located. 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. • Application for Special Designated License Under Nebraska Liquor Control Act Affidavit of Non-Profit Status 1 HEREBY DECLARE THAT THE CORPORATION MAKING APPLICATION FOR A SPECIAL DESIGNATED LICENSE UNDER THE NEBRASKA LIQUOR CONTROL ACT IS EITHER A MUNICIPAL CORPORATION, A FINE ARTS MUSEUM INCORPORATED AS A NONPROFIT CORPORATION, A RELIGIOUS NONPROFIT CORPORATION WHICH HAS BEEN EXEMPTED FROM THE PAYMENT OF FEDERAL INCOME TAXES, A POLITICAL ORGANIZATION WHICH HAS BEEN EXEMPTED FROM THE PAYMENT OF FEDERAL INCOME TAXES,OR ANY OTHER NONPROFIT CORPORATION,THE PURPOSE OF WHICH IS FRATERNAL,CHARITABLE,OR PUBLIC SERVICE AND WHICH HAS BEEN EXEMPTED FROM THE PAYMENT OF FEDERAL INCOME TAXES AS PER§53-124.11(1). AS SIGNATORY I CONSENT TO THE RELEASE OF ANY DOCUMENTS SUPPORTING THIS DECLARATION AND ANY DOCUMENTS SUPPORTING THIS DECLARATION WILL BE PROVIDED TO THE NEBRASKA LIQUOR CONTROL COMMISSION, THE NEBRASKA STATE PATROL OR ANY AGENT OF THE LIQUOR CONTROL COMMISSION IMMEDIATELY UPON DEMAND. I ALSO CONSENT TO THE INVESTIGATION OF THIS CORPORATE ENTITY TO DETERMINE IT'S NONPROFIT STATUS. I AGREE TO WAIVE ANY RIGHTS OR CAUSES OF ACTION AGAINST THE NEBRASKA LIQUOR CONTROL COMMISSION, THE NEBRASKA STATE PATROL OR ANY PARTY RELEASING INFORMATION TO THE AFOREMENTIONED PARTIES. ( ,r(!et'1 cicR. ' -I G,\t 0.YZ C\ Cc c 5 Q,-L\ NAME OF CORPORATION (} FEDERAL ID NUMBER /117 la./7-11// SIGN* Ii�OF TITLE OF CORTORATE OFFICERS THE ABOVE INDIVIDUAL STATES THAT THE STATEMENT ABOVE IS TRUE AND CORRECT:IF ANY FALSE STATEMENT IS MADE ON THIS APPLICATION,THE APPLICANT SHALL BE DEEMED GUILTY OF PERJURY AND SUBJECT TO PENALTIES PROVIDED BY LAW. (SEC. §53- 131.01)NEBRASKA LIQUOR CONTROL ACT SUBSCRIBED IN MY PRESENCE AND SWORN TO BEFORE ME THIS rA DAY OF "cda 200q . GENERAL NOTARY-State of Nebraska i SUSAN K.LAUMAN e My Comm.Exp.March 17,2010 .....A.aait NOTARY PUBLIC SIGNATURE&SEAL 1 icant Title . Date Orli-1-z:4 Mo.VV U�� Print Name The law requires that no special designated license provided for by this section shall be issued by the Commission without the approval of the local governing body. For the purposes of this section,the local governing body shall be the city or village within which the particular place for which the special designated license is requested is located, or if such place is not within the. corporate limits of a city or village,then the local governing body shall be the county within which the place for which the special designated license is requested is located. 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. „HA, ,v4, City of Omafia, Nebraska �1I 4)_ 1819 Farnam— Suite LC 1 ® Er d �, 02 Omaha, Nebraska 68183-0112 ' �' Buster Brown (402) 444-5550 City Clerk FAX (402) 444-5263 041.ED FEaRr.A July 14, 2009 American Italian Heritage Society Application for Special Designated P. O. Box 27176 License for September 4-6, 2009 at Omaha, NE 68127 Roncalli Catholic High School, 6401 Sorensen Pkwy. Music till Midnight each night. Dear Liquor License Applicant: This letter is notification that a hearing before the Omaha City Council on your application(s) for a Special Designated 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(s) to the Nebraska Liquor Control Commission. Sincerely yours, /1) e c c der Buster Brown City Clerk BJB:clj AME OF CORPORATION (} FEDERAL ID NUMBER /117 la./7-11// SIGN* Ii�OF TITLE OF CORTORATE OFFICERS THE ABOVE INDIVIDUAL STATES THAT THE STATEMENT ABOVE IS TRUE AND CORRECT:IF ANY FALSE STATEMENT IS MADE ON THIS APPLICATION,THE APPLICANT SHALL BE DEEMED GUILTY OF PERJURY AND SUBJECT TO PENALTIES PROVIDED BY LAW. (SEC. §53- 131.01)NEBRASKA LIQUOR CONTROL ACT SUBSCRIBED IN MY PRESENCE AND SWORN TO BEFORE ME THIS rA DAY OF "cda 200q . GENERAL NOTARY-State of Nebraska i SUSAN K.LAUMAN e My Comm.Exp.March 17,2010 .....A.aait NOTARY PUBLIC SIGNATURE&SEAL 1 icant Title . Date Orli-1-z:4 Mo.VV U�� Print Name The law requires that no special designated license provided for by this section shall be issued by the Commission without the approval of the local governing body. For the purposes of this section,the local governing body shall be the city or village within which the particular place for which the special designated license is requested is located, or if such place is not within the. corporate limits of a city or village,then the local governing body shall be the county within which the place for which the special designated license is requested is located. 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. % b Enii - N O 7- O d - › O N (D O O 'a I ' - 00 �r r�-� O 0O CD CD (D „ O n Ca. (D .: CP \ _ al. cr'4. .-) ' ..i. a0 O 00 p CT `t ° O nCD „ V -• N '-' 'TJ W F•d O flh 0 O O VD 0 1 Social Security Number: /r Drivers License Number& State: Date Of Birth: Place Of Birth: CITY&STATE YEAR CITY&STATE YEAR FROM TO FROM TO YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER FROM TO l°' Form 3c Page 2 = II, - •a- 28go Form 3c Page 2