RES 2009-0248 - Appoint Tara Timberlake manager of MVP Lounge --TFp4,
(4% -�- �� STATE OF NEBRASKA
r `,77 . tom- }V
0 Dave Heineman NEBRASKA LIQUOR CONTROL COMMISSION
tit Nf f�-- ''V Governor Hobert B. Rupe
ip , B�;, , 09 FEB ° 20 Executive Director
Cf7 lm��a_=` f �� t IKt ��`
"�. 301 Centennial Mall South,5th Floor
s r P.O.Box 95046
rJ l ' `^ !t Lincoln,Nebraska 68509-5046
OMAHA, NEB A i 1 Phone(402)471-2571
February 24, 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: ROLATI INC
DBA: M.V.P. LOUNGE •
LICENSE #C-14489
Dear Clerk:
Enclosed is a copy of a manager application for TARA TIMBERLAKE in connection with ROLATI INC;
DBA: M.V.P. LOUNGE. Located at 5434 S 99TM ST; OMAHA 68127. The Liquor License # is C-14489.
Please present this application for manager to your CityNillage Council or County
Commissioners and send us the results of their action.
Sincerely,
NEBRASKA LIQUOR CONTROL COMMISSION
\44)-J't;e7rIZA,
Kristina Radicia
Licensing Division
end.
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
MANAGER APPLICATION Office Use
INSERT-FORM 3c
NEBRASKA LIQUOR CONTROL COMMiSSION
301 CENTENNIAL MALL SOUTH •
PO BOX 95046
LINCOLN,NE 68509-5046
Pi-IONE.(402)471-2571
FAX:(402)471-2814
Website:www.Icc.ne.Kov .
Corporate manager,including spouse,are required to adhere to the following requirentepts,
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
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Form 3c Page 2
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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.
nYES 4
NO 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 n me of the premise.
OYES O
3. Do you, as a manager, have all the qualifications required to hold a Nebraska Liquor License? Nebraska
4' uor Control Act (053-131.01)
ES 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 person)
OES [NO
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: ,.
. .�� 7__ . �F � ty -. AL)
i •
Form 3c Page 3
•.c_°
Spouses Last Name: First Name: - MI:
Social Security Number: Drivers License Number. & State:
Date Of Birth: Place Of Birth:
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YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER
FROM TO
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Form 3c Page 2
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.
•
Signat re anager Applicant Signature of Spouse
State of Nebraska
County of R..?4/ County of
The foregoing instrument was acknowledged before The foregoing instrument was acknowledged before
Lo
me this ' Aebm.� zt)v9 by me this by
Not P bli signature Notary Public signature
Affix Sgrl Here KIRK GOODNIGHT Affix Seal Here
State of Nebraska-General Notary
My Commission Expires
December 07,2011
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 9/2008
Form 3c Page 4
erson)
OES [NO
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: ,.
. .�� 7__ . �F � ty -. AL)
i •
Form 3c Page 3
•.c_°
Spouses Last Name: First Name: - MI:
Social Security Number: Drivers License Number. & State:
Date Of Birth: Place Of Birth:
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CITY&STATE YEAR CITY&STATE YEAR
FROM TO FROM TO
(1) (0-1 N) 1034 H2 . ,-,
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YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER
FROM TO
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Form 3c Page 2
O�p'WA' �'F
City ofOmaha, Wthras&a 0 r' 4b9Eiritijel
jo
��
1819 Farnam —Suite LC 1 ', V
Omaha, Nebraska 68183-0112
Buster Brown (402) 444-5550 ',y�''
City Clerk FAX (402) 444-5263 o�RTFD
March 3, 2009
Rolati, Inc. Application to appoint Tara Timberlake
Dba"M.V.P. Lounge" manager of your present Class "C"
5434 South 99th Street Liquor License
Omaha, NE 68127
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 March 17.
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
nt was acknowledged before The foregoing instrument was acknowledged before
Lo
me this ' Aebm.� zt)v9 by me this by
Not P bli signature Notary Public signature
Affix Sgrl Here KIRK GOODNIGHT Affix Seal Here
State of Nebraska-General Notary
My Commission Expires
December 07,2011
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 9/2008
Form 3c Page 4
erson)
OES [NO
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: ,.
. .�� 7__ . �F � ty -. AL)
i •
Form 3c Page 3
•.c_°
Spouses Last Name: First Name: - MI:
Social Security Number: Drivers License Number. & State:
Date Of Birth: Place Of Birth:
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Form 3c Page 2
ovixHA, 1y4,
84,
CityofOmaha fAlebras&a :� � ' ���
1 , fir, .
1819 Farnam—Suite LC 1 2` ti -�
Omaha, Nebraska 68183-0112 o,.1 s ',
Buster Brown (402) 444-5550 � ey
City Clerk FAX (402) 444-5263 0�91'ED FEB "
March 3, 2009
Tara Timberlake Application to be appointed manager of the present
7417 Harvest Hill Drive Class "C" Liquor License for Rolati, Inc., dba "M.V.P.
LaVista,NE 68128 Lounge", 5434 South 99th 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 March 17,
2009. The City Council Meeting begins at 2:00 P.M. in the Legislative Chamber, (LC-
4), Omaha/Douglas Civic Center, 1819 Famam 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
instrument was acknowledged before
Lo
me this ' Aebm.� zt)v9 by me this by
Not P bli signature Notary Public signature
Affix Sgrl Here KIRK GOODNIGHT Affix Seal Here
State of Nebraska-General Notary
My Commission Expires
December 07,2011
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 9/2008
Form 3c Page 4
erson)
OES [NO
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: ,.
. .�� 7__ . �F � ty -. AL)
i •
Form 3c Page 3
•.c_°
Spouses Last Name: First Name: - MI:
Social Security Number: Drivers License Number. & State:
Date Of Birth: Place Of Birth:
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