RES 2008-1330 - Appoint Debbie Arroyo manager of Infinite f
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Y s �' < , • � ; s I STATE OF NEBRASKA
i : it.7 u 1, h i NEBRASKA LIQUOR CONTROL COMMISSION
ra)�;,\,���! �,.a'� Dave Heineman
,. Governor �, t r �� a Hobert B. Rupe
4N ! i E "u I Executive Director
' 301 Centennial Mall South,5th Floor
/ P.O.Box 95046
`; C! +w',K Lincoln,Nebraska 68509-5046
k 4. , s Phone(402)471-2571
Fax(402)471-2814
TRS USER 800 833-7352(TTY)
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September 4, 2008 web address:http://www.lcc.ne.gov/
OMAHA CITY CLERK
1819 FARNAM STREET , SUITE LC-1
OMAHA NE 68183
Re: B &A PETROLEUM CORP
DBA INFINITE
License # D-79520
Dear Clerk:
Enclosed is a copy of a manager application for DEBBIE ARROYO in connection INFINITE located at
2302 S 13th Street Omaha NE 68108, Liquor License # D-79520.
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
Tami Applebee
Licensing Division
encl.
cc: file
Rhonda R.Flower Bob Logsdon Robert Batt
Commissioner Chairman Commissoner
An Equal Opportunity/Affirmative Action Employer
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Printed with soy ink on recycled paper
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MANAGER APPLICATION t orree Use
INSERT-FORM 3c
, NEBRASKA LIQUOR CONTROL COMMISSION RECEIVED
301 CENTENNIAL MALL SOUTH
' PO BOX 95046
LINCOLN,NE 68509-5046 �f�U;!
• PHONE:(402)471-2571 AUG
G 29
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• FAX:(402)471-2814 •
Website: w�v.lcc.ne.eov NEBRASKA LIQUOR
cntanni cnMMIP.SIAN
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Corporate manager,including their spouse,are required to adhere to the following requirements
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1) Must be a citizen of the United States •
2) Must be'a Nebraska resident(Chapter 2-006)
3) Must provide.a copy of their certified birth certificate or INS papers •
4) Must submit their 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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Name of Corporation/LLC: 4 A 4 riro%u �P/0 • • • •
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Premise License Number: D 7�S-ZD
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Premise Trade Name/DBA: /'2`i/7i .e.
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Premise Street Address: a 6 o�2 .So .• /3 " - .
City: ' ./�,a-he ..•.. State: /✓/ Zip Code: G 45/O
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: .CORPORATE OFFICER SIGNATURE • • •
(Faxed signatures are acceptable) • .
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0800016707' .
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4-103411,'", 'A`-?1,1V-i4. 4-vt 41,
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Gender: 0 MALE Sj FEMALE
Last Name: ,4,6e.e' e, First Name: Lee/(::-• MI:
Home Address(include PO Box if applicable): 144 6 Ai, I
City: ,4/21,4ci$142- State: lIE Zip Code: ógli6rd
Home Phone Number: '12/Z14 - 7,e1 6 -.? Business Phone Number: /IPA
Social Security Number:_ Drivers License Number&State:
Date Of Birth: Place Of Birth: 200, O4.
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Spouses Last Name: First Name:
MI:
Social Security Number: Drivers License Number&State:
Date Of Birth: Place Of Birth:
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Premise License Number: D 7�S-ZD
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Premise Trade Name/DBA: /'2`i/7i .e.
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Premise Street Address: a 6 o�2 .So .• /3 " - .
City: ' ./�,a-he ..•.. State: /✓/ Zip Code: G 45/O
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: .CORPORATE OFFICER SIGNATURE • • •
(Faxed signatures are acceptable) • .
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0800016707' .
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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.
OYES TO 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.
OYES TKO
3. Do you,as a manager,have all the qualifications required to hold a Nebraska Liquor License? Nebraska
Liquor Control Act(§53-131.01)
EKES ONO
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)
E ES ONO
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Premise License Number: D 7�S-ZD
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Premise Trade Name/DBA: /'2`i/7i .e.
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Premise Street Address: a 6 o�2 .So .• /3 " - .
City: ' ./�,a-he ..•.. State: /✓/ Zip Code: G 45/O
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Premise-Phone Number: 'n ,i/e., i,/tj-•����-,/ (�•—s� cJ — igge,
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: .CORPORATE OFFICER SIGNATURE • • •
(Faxed signatures are acceptable) • .
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0800016707' .
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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. If
spouse has NO interest directly or indirectly,a spousal affidavit of non participation may be attached.
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.
,.../ , le vs c
Signature Manager Applicant S nature of Spouse
State of Nebraska
County of Q,S County of
The foregoing instrulne t was acknowledged before The foregoing instrument was acknowledged before
me this 25`" 4-- by me this by
No Public signature Notary Public signature
Affix Seal Here Affix Seal Here
GENERAL NOTARY-State of Nebraska
MEEGAN THIBODEAU
e Hy Comm.Exp.Aug.6,2011
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 5/2007
1
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Premise License Number: D 7�S-ZD
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•
Premise Trade Name/DBA: /'2`i/7i .e.
•
Premise Street Address: a 6 o�2 .So .• /3 " - .
City: ' ./�,a-he ..•.. State: /✓/ Zip Code: G 45/O
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Premise-Phone Number: 'n ,i/e., i,/tj-•����-,/ (�•—s� cJ — igge,
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: .CORPORATE OFFICER SIGNATURE • • •
(Faxed signatures are acceptable) • .
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0800016707' .
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KELLEY, JERRAM Ft KOHOUT, P.C., L.L.O.
Fv DD
esvri st..Zawb
7134 PACIFIC STREET
MICHAEL A.KILIEY(NE) OMAHA. NE$RASKA eslos LINCOLN OFFICE
CHRISTOPHER O.JERRAM(NE.MO 0 Ka► TELEPHONE (402)307.1111011 1125 SOUTH 14TH STREET.SUITE 5
JOSEPH D. KONOUT(NI) LINCOLN.NESRASKA Sa60a
FACSIMILE 1403)aa7-1205
TELEPHONE(402)474.2202
TOM KELLEY(ti1i.{SSO) FACSIMILE(402)474.4052
MISSOURI OFFICE
060 SAYSIRRY LANE,SUITE{db
LEE'S SUMMIT,MISSOURI 44064
TELEPHONE(5111)472-4520
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August 27,2008
Nebr Liquor Control Commission RECEIVED
Licensing Division
PO Box 95046 al 29 2003
Lincoln NE 68509-5046
NEBRASKA UOUOR
Re: B&K Petroleum Corp.,d/b/a Infinite CONTROL COMMISSION
M&A Petroleum Corp.,d/b/a Infinite
B&A Petroleum Corp.,d/b/a Infinite
Enclosed please find new corporate manager applications for the above-referenced licensees.
Please be advised that Debbie Arroyo was unable to locate her birth certificate and has had to
request a duplicate from the State of Nebraska. We will provide a copy of that document as soon
as it is received.
Sin - ��"
re" /19:
144,ger , .yl:
•si : 1, .1 Mic I. 1 A.Kelley
County of Q,S County of
The foregoing instrulne t was acknowledged before The foregoing instrument was acknowledged before
me this 25`" 4-- by me this by
No Public signature Notary Public signature
Affix Seal Here Affix Seal Here
GENERAL NOTARY-State of Nebraska
MEEGAN THIBODEAU
e Hy Comm.Exp.Aug.6,2011
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 5/2007
1
{
Premise License Number: D 7�S-ZD
•
•
Premise Trade Name/DBA: /'2`i/7i .e.
•
Premise Street Address: a 6 o�2 .So .• /3 " - .
City: ' ./�,a-he ..•.. State: /✓/ Zip Code: G 45/O
. • q
Premise-Phone Number: 'n ,i/e., i,/tj-•����-,/ (�•—s� cJ — igge,
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