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RES 2008-1333 - Appoint Scott Schlatte manager of Hy-Vee Drugstore ^ --4 8ES Tq 2,•„„, STATE OF NEBRASKA NEBRASKA LIQUOR CONTROL COMMISSION Dave Heineman �; 4 ar,'a Governor f;;. S F k -S{ tI P" 0, V �( ' Hobert B. Rupe 4ii1\\\y'R• ' Q6I_- Executive Director 301 Centennial Mall South,5th Floor 1, i + " ,``. x P.O.Box 95046 Lincoln,Nebraska 68509-50461 3 - e, Phone(402)471-2571 September 2, 2008 Fax(402)471-2814 TRS USER 800 833-7352(TTY) web address:http://www.lcc.ne.gov/ City Clerk of Omaha 1819 Farnam LC1 Omaha, NE 68183 \..5 S-�m RE: Manager Application Submittal Dear Sir/Madam: The corporation Hy-Vee Inc submitted the enclosed Application for Corporate Manager and has liquor license(s) Class C 53852, 51154, 44705, 79663, 55723, 68147, 45325, 55177, Class CK 51206, 66924, 45546 and Class D 66730, 54894 and 71852. The applicant's name is Scott A Schlatter Please present this application to your City/County Council and return the results of the action taken to our office. If you have any questions or comments, please give me a call at (402) 471 -4881 . Sincerely, r Jackie B. Matulka Licensing Division Enclosure Rhonda R.Flower Bob Logsdon • Robert Batt Commissioner Chairman Commissoner An Equal Opportunity/Afrmatiue Action Employer Printed with soy ink on recycled paper 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. . . ...._1, . ,. . • • . . AIO .‘gi3O LIS A` . . . Signature • Manager'Applicant Sithatire.of Spouse • State of Nebraska- - • . ' - • County of . q S ..• • County of • The foregoing instru e-twas:acknowledged.before.:.. -. .The foregoing instrument was acknowledged:before •• . .. me this Z54'h . .t l�j. •try` . • me this.:. . . • :by. . • • • : ' el$A3144b0.‘ AtZ;<:- ,i• • • No,; Public..siguature. • . ' Notary Public.Sign.ature • Affix Seal Here Affix Seal Here GENERAL NOTARY•State of Nebta0a MEEGAN THIBODEAU �''°'1' My Comm.Exp.Aug.6,2011 • In compliance with the ADA,this manager insert form 3c is available in other formats for persons with disabilities. • A ten day advance period is required in writing to produce the alternate format. - • . Revised 5/I007 re acceptable) 0800016708 . .9i::�:5•. _3<,. 3'.�j:"�,... �:.,;� 1.+. tk, X:..y,!, f..,. _Si?.:: Cr•d"�rk.>•,: +d.:•_._e.u ...c'.'.:;5'r.•..:...{^f:�sei:.F.:i^...:a...,...J.e•�,,. �•"+L7J.`,1>u,iiv.F:h.,dY:sY R-`:.•irv.ne. ,r. i-.i:..7+:7 ....._3•kti:+a•:' o:ka$a�'},.n�w<......<.. :'S`L"�!•.tew.,.....s;' �a�i :.-i�1'X'.:;,.'i..n.s.:...k3,=a.L,..1,1 • • f .' 1 4( r• r . . . . : .CORPORATE OFFICER SIGNATURE • • • (Faxed signatures are acceptable) • . • • . 0800016707' . 1 . i . MANAGER APPLICATION Office Use INSERT-FORM 3c NEBRASKA LIQUOR CONTROL COMMISSION EC E I VED 301 CENTENNIAL MALL SOUTH PO BOX 95046 AUGn LINCOLN,NE 68509-5046 AU c7 2008 PHONE:(402)471-2571 FAX:(4 2)w w.lcc. 4 e. NEBRASKA LIQUOR Website:www.lcc.ne.gov Cflnlron, c'nn44.41SSIQN Corporate manager,including their spouse,are required to adhere to the following requirements 1) Must be a citizen of the United States 2) Must be a Nebraska resident(Chapter 2—006) (sf' 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 .i;ir�t►'=ii:�A[.tltr�,_L..�;i nlseer.Yn:+li..Y.—_.4.._.__ .�_.��__._._ -r.._:._...�l��-...._ __". .�—.._..�..__.....~- ...,-....,..-.....--». Name of Corporation/LLC: Hy-Vee, Inc - r .c ; ..,, . . a: • s� -�.+ •,T„-'-,ri-.,-� a .,,.,. .Y_ .. _...- .a..� ..... .. .. !. _—fs..r,.ti ._.'�•ri 9• . Premise License Number:79663 Premise Trade Name/DBA:Hy-Vee Drugstore Premise Street Address: 8404 N 30TH ST ' City:Omaha State: NE Zip Code:68112 Premise Phone Number:(402)451-8843 • h• tins" 1!ual,Whose.name.is hs a!l .t ei t resl I • or.c' r •c �! t r a i a Olt r 1#1 @L'�. Q 13ar01Cc .1 •r-n s-F--- r "." "ems--•7 . w.. i�.K� y � wrsrxvttr«uc :`^k, -.? r t 7•t:. t - e i '".k se""' .-fir* -FT Cs .4 -r. -, -:-�".y""'�i+�'T•,..t "4:. • -�.°, ,.; 'ar CORPORATE OFFICER SIGNATURE (Faxed signatures are acceptable) KEVIN REEVE Sir?ACE FR D ,CONTROLLER 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. . . ...._1, . ,. . • • . . AIO .‘gi3O LIS A` . . . Signature • Manager'Applicant Sithatire.of Spouse • State of Nebraska- - • . ' - • County of . q S ..• • County of • The foregoing instru e-twas:acknowledged.before.:.. -. .The foregoing instrument was acknowledged:before •• . .. me this Z54'h . .t l�j. •try` . • me this.:. . . • :by. . • • • : ' el$A3144b0.‘ AtZ;<:- ,i• • • No,; Public..siguature. • . ' Notary Public.Sign.ature • Affix Seal Here Affix Seal Here GENERAL NOTARY•State of Nebta0a MEEGAN THIBODEAU �''°'1' My Comm.Exp.Aug.6,2011 • In compliance with the ADA,this manager insert form 3c is available in other formats for persons with disabilities. • A ten day advance period is required in writing to produce the alternate format. - • . Revised 5/I007 re acceptable) 0800016708 . .9i::�:5•. _3<,. 3'.�j:"�,... �:.,;� 1.+. tk, X:..y,!, f..,. _Si?.:: Cr•d"�rk.>•,: +d.:•_._e.u ...c'.'.:;5'r.•..:...{^f:�sei:.F.:i^...:a...,...J.e•�,,. �•"+L7J.`,1>u,iiv.F:h.,dY:sY R-`:.•irv.ne. ,r. i-.i:..7+:7 ....._3•kti:+a•:' o:ka$a�'},.n�w<......<.. :'S`L"�!•.tew.,.....s;' �a�i :.-i�1'X'.:;,.'i..n.s.:...k3,=a.L,..1,1 • • f .' 1 4( r• r . . . . : .CORPORATE OFFICER SIGNATURE • • • (Faxed signatures are acceptable) • . • • . 0800016707' . 1 . -• '7 sue. 1 izq a aid' N • t xgaa "S�_— •:3_ � r 1/att 0 1• 6 I a I rb 0 1 a / 0 �, a3 'e t a �� t , x , "n.• ...;•,aak -- -. 'x "'"` .�, ''As§` .i-=i t da ,f ra^ '�t `:•p.ai' �.S-•-, `` Gender: ❑✓ MALE ❑FEMALE Last Name: Schlatter First Name: Scott MI:A. Home Address(include PO Box if applicable):3325 Longview Ct City: Lincoln State:NE Zip Code: 68506 Home Phone Number:402-483-2137 Business Phone Number: 402-489-4244 Social Security Number:1 Drivers License Number&State: NE Date Of Birth: ( Place Of Birth: Sumner, IA a :Ili LIA13—� C i a s i i•a)eii [a i e• 6 0 6 1 p�4 i 8: (•ef: 113.m. Itw / 1 f -`fF .!3 LSR otE DYES ❑NO S10 trAftatirdiv130.11 - .L l 3 c.. se xy 3 O • Spouses Last Name:Schlatter First Name: Deborah MI: M Social Security Number: ' Drivers License Number& State: NE Date Of Birth: Place Of Birth:West Union, IA Inc �i Hai �r i 0•-a dE u EA 9� toil to4.`�C• E.WO ria.%ola �dGo 1vs E.e � tl litoo inw4 w , •? _ , E'...is---" Fu�.. ,_ , .. CITY&STATE YEAR CITY&STATE YEAR FROM TO FROM TO 3325 Longview Ct., Lincoln, NE 2007 Curr 3325 Longview Ct., Lincoln, NE 2007 Curr 5932 S 81st St, Lincoln, NE 2003 2007 5932 S 81st St, Lincoln, NE 2003 2007 Lee's Summit, MO 2000 2003 Lee's Summit, MO 2000 2003 Ralston, NE 1995 2000 Ralston, NE 1995 2000 3 � - ••� • ��E d • T � Fn7 n Q,.3 J..lj yta . SC if I ' a t . 'F t` k Uf +rm �[s {1`.�r n v; l YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER FROM TO 1990 Curr Hy-Vee, Inc Pat Hensley 515-267-2800 1988 1990 Milwaukee Biscut Co Rich Baker N/A owledge 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. . . ...._1, . ,. . • • . . AIO .‘gi3O LIS A` . . . Signature • Manager'Applicant Sithatire.of Spouse • State of Nebraska- - • . ' - • County of . q S ..• • County of • The foregoing instru e-twas:acknowledged.before.:.. -. .The foregoing instrument was acknowledged:before •• . .. me this Z54'h . .t l�j. •try` . • me this.:. . . • :by. . • • • : ' el$A3144b0.‘ AtZ;<:- ,i• • • No,; Public..siguature. • . ' Notary Public.Sign.ature • Affix Seal Here Affix Seal Here GENERAL NOTARY•State of Nebta0a MEEGAN THIBODEAU �''°'1' My Comm.Exp.Aug.6,2011 • In compliance with the ADA,this manager insert form 3c is available in other formats for persons with disabilities. • A ten day advance period is required in writing to produce the alternate format. - • . Revised 5/I007 re acceptable) 0800016708 . .9i::�:5•. _3<,. 3'.�j:"�,... �:.,;� 1.+. tk, X:..y,!, f..,. _Si?.:: Cr•d"�rk.>•,: +d.:•_._e.u ...c'.'.:;5'r.•..:...{^f:�sei:.F.:i^...:a...,...J.e•�,,. �•"+L7J.`,1>u,iiv.F:h.,dY:sY R-`:.•irv.ne. ,r. i-.i:..7+:7 ....._3•kti:+a•:' o:ka$a�'},.n�w<......<.. :'S`L"�!•.tew.,.....s;' �a�i :.-i�1'X'.:;,.'i..n.s.:...k3,=a.L,..1,1 • • f .' 1 4( r• r . . . . : .CORPORATE OFFICER SIGNATURE • • • (Faxed signatures are acceptable) • . • • . 0800016707' . 1 . =,. ^+= -:r a e�- A �1/ 9ai . Yaie n® t ite i5 Cia Rt a a itx, o-g1e rda 1v a ef; a la e i - kY3 E,i���a � -1e t� �-`�o 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 ONO 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 ONO 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 fingerprint cards and PROPER FEES with this application? (The check or money order must be made out to the Nebraska State Patrol for$38.00 per person) ©YES ONO • •• .. CITY&STATE YEAR CITY&STATE YEAR FROM TO FROM TO 3325 Longview Ct., Lincoln, NE 2007 Curr 3325 Longview Ct., Lincoln, NE 2007 Curr 5932 S 81st St, Lincoln, NE 2003 2007 5932 S 81st St, Lincoln, NE 2003 2007 Lee's Summit, MO 2000 2003 Lee's Summit, MO 2000 2003 Ralston, NE 1995 2000 Ralston, NE 1995 2000 3 � - ••� • ��E d • T � Fn7 n Q,.3 J..lj yta . SC if I ' a t . 'F t` k Uf +rm �[s {1`.�r n v; l YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER FROM TO 1990 Curr Hy-Vee, Inc Pat Hensley 515-267-2800 1988 1990 Milwaukee Biscut Co Rich Baker N/A owledge that any license issued, based on the information submitted in this application, is subject to cancellation if the information contained herein is incomplete,inaccurate,or fraudulent. . . ...._1, . ,. . • • . . AIO .‘gi3O LIS A` . . . Signature • Manager'Applicant Sithatire.of Spouse • State of Nebraska- - • . ' - • County of . q S ..• • County of • The foregoing instru e-twas:acknowledged.before.:.. -. .The foregoing instrument was acknowledged:before •• . .. me this Z54'h . .t l�j. •try` . • me this.:. . . • :by. . • • • : ' el$A3144b0.‘ AtZ;<:- ,i• • • No,; Public..siguature. • . ' Notary Public.Sign.ature • Affix Seal Here Affix Seal Here GENERAL NOTARY•State of Nebta0a MEEGAN THIBODEAU �''°'1' My 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/I007 re acceptable) 0800016708 . .9i::�:5•. _3<,. 3'.�j:"�,... �:.,;� 1.+. tk, X:..y,!, f..,. _Si?.:: Cr•d"�rk.>•,: +d.:•_._e.u ...c'.'.:;5'r.•..:...{^f:�sei:.F.:i^...:a...,...J.e•�,,. �•"+L7J.`,1>u,iiv.F:h.,dY:sY R-`:.•irv.ne. ,r. i-.i:..7+:7 ....._3•kti:+a•:' o:ka$a�'},.n�w<......<.. :'S`L"�!•.tew.,.....s;' �a�i :.-i�1'X'.:;,.'i..n.s.:...k3,=a.L,..1,1 • • f .' 1 4( r• r . . . . : .CORPORATE OFFICER SIGNATURE • • • (Faxed signatures are acceptable) • . • • . 0800016707' . 1 . i . 1'1. M6 Iff.t.ls yidE :V Alt.lto 61 s,,I,._D4.0 a6 i5 kVA _ . 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. ,L- . Signature of Manager Applicant Signature of Spouse State of Nebraska County of County of ,cc The foregoing ns ment was acknowledged before The foregoin ins ment was acknowledged before me this g �2g S by me this 8 .ag1 by 9«t <� NotaryPublic • ature NotaryPublic nature A Seal Here A ' Seal Here KEVIN J. GOURKA 1 KEVIN J. GOURKA General Notary SMeral Notary State of Nebraska My Commission ExpUes Febaska 1 My Commission.Expires Feb 10, 2009 State ew imp 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 mitted in this application, is subject to cancellation if the information contained herein is incomplete,inaccurate,or fraudulent. . . ...._1, . ,. . • • . . AIO .‘gi3O LIS A` . . . Signature • Manager'Applicant Sithatire.of Spouse • State of Nebraska- - • . ' - • County of . q S ..• • County of • The foregoing instru e-twas:acknowledged.before.:.. -. .The foregoing instrument was acknowledged:before •• . .. me this Z54'h . .t l�j. •try` . • me this.:. . . • :by. . • • • : ' el$A3144b0.‘ AtZ;<:- ,i• • • No,; Public..siguature. • . ' Notary Public.Sign.ature • Affix Seal Here Affix Seal Here GENERAL NOTARY•State of Nebta0a MEEGAN THIBODEAU �''°'1' My 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/I007 re acceptable) 0800016708 . .9i::�:5•. _3<,. 3'.�j:"�,... �:.,;� 1.+. tk, X:..y,!, f..,. _Si?.:: Cr•d"�rk.>•,: +d.:•_._e.u ...c'.'.:;5'r.•..:...{^f:�sei:.F.:i^...:a...,...J.e•�,,. �•"+L7J.`,1>u,iiv.F:h.,dY:sY R-`:.•irv.ne. ,r. i-.i:..7+:7 ....._3•kti:+a•:' o:ka$a�'},.n�w<......<.. :'S`L"�!•.tew.,.....s;' �a�i :.-i�1'X'.:;,.'i..n.s.:...k3,=a.L,..1,1 • • f .' 1 4( r• r . . . . : .CORPORATE OFFICER SIGNATURE • • • (Faxed signatures are acceptable) • . • • . 0800016707' . 1 . , SPOUSAL AFFIDAVIT OF Office Use NON PARTICIPATION INSERT r NEBRASKA LIQUOR CONTROL COMMISSION RECEIVED 301 CENTENNIAL MALL SOUTH PO BOX 95046 LINCOLN,NE 68509-5046 AUG 2 9 2008 PHONE:(402)471-2571 FAX:(402)471-2814 Website: www.lcc.ne.gov NFBRASKA LIQUOR _ •► 1;• • l I• N P " `a®a'') •f ea -lc -.io e e a`u e e a a o�Y' . a e"tc I maa ff".10 O..j a o ae " a . .a i0 1 oI�A - Fe ta-x'S>xs ;':-ram l.t:..'3"c"'�•--3�'• a'i 5'N:13 � interestke t 121,e.. ec a_ s e e tlba-.Asxcia.t o i. a eusmessil • "3 ,53. 33 •"O fir _NO a 0„l a"O -c " ` IIAno ill Fie ar ak saIP --se a e a1r0 a O a C!I — 1 e C I i i a e iC,e Wrir a resen rl ,e pia • a e e-o :.?1 fl 3 �'a.apxa a'a a e� pee, apaa o is a a U(U a. o 0 as ee o I Ti' e.w 7- a Hre a =h e •0.�- Sa�O v tg$ a 77�g a e-d1�`1 c ili oma ono � 8p spap onsIB-4aex� 6Cr�St l• L�� �,x'°�'€�t'�.as�""w�"xi ,zi�`�c.,.. -i ...�.>...r�^c "v'�.,a+b- -.. ,...._..,�..._.._.,—.� --•"-�.'fix -mks Itz i -------- ,%i4 bsebbrah Sc.h 1a44-ex Signature of spouse asking for waiver- Printed name of spouse asking for waiver (Spouse of individual listed below) State of 4P-t-luit, County of The foregoing instrument was acknowledged before me this age by 2eg0Aali a telle2. date name of person acknowledged /J k/"Yh Affix Se. KiViN J. GOURKA Notary Pu c signature ; $lot•Gof Nab Notary MY CommIu4on EXDU.1 Fab 10 21109 i g— —_ a li a tlf s ►'-ieY t pab 4. a e a Niel:-• a oV a e e a lift, 6✓'t iTh ao a "", ea at-i "�- a o a_Sge.wore, - o as�. r as � a to ��e s•a e ..�`�pr o a.. ��� � �� a eerie e� �`10 0���6ajo��t����of�� •��e�a� 3��k '.�-'? ��a,: .. . !. w..a4--.s.-x-- , -*-- -.�.'-e�Y; r-: , "r_'.-4-- x-- .n`'.s. 54 - ,s5;3 t ... 3�% Ca aii'ea- o i6ai� • AT • »°..:.' a t.�a.�+l' o��w a t ?_ .. �";' 3.;� ,_n.,rz�s fir-, = ° r &o f SC hk f Si_ attire of individual involved with application Printed name of applying individual (Spouse of individual li ed above) d\k} State of 4d-'Ut, County of o-vcaA,_/t The foregoing instrument rwas acknowledged before me this j .gfr by Gct SG�1 LGTr4ate n name of person acknowledged 7 'vi �''oi Affix Seal ; • s Notary Publigna///tur��e\\JJ 4 GOURKA pWroJ. Noj ary 1 Mat*of Nf►bfa*O ...as ab 10. 2009 In compliance with the ADA,this spousal affidavit of non participation is available in other fo A ten day advance period is requested in writing to produce the alternate format. , FORM 35-4178 Revised 1/2008 6,2011 • In compliance with the ADA,this manager insert form 3c is available in other formats for persons with disabilities. • A ten day advance period is required in writing to produce the alternate format. - • . Revised 5/I007 re acceptable) 0800016708 . .9i::�:5•. _3<,. 3'.�j:"�,... �:.,;� 1.+. tk, X:..y,!, f..,. _Si?.:: Cr•d"�rk.>•,: +d.:•_._e.u ...c'.'.:;5'r.•..:...{^f:�sei:.F.:i^...:a...,...J.e•�,,. �•"+L7J.`,1>u,iiv.F:h.,dY:sY R-`:.•irv.ne. ,r. i-.i:..7+:7 ....._3•kti:+a•:' o:ka$a�'},.n�w<......<.. :'S`L"�!•.tew.,.....s;' �a�i :.-i�1'X'.:;,.'i..n.s.:...k3,=a.L,..1,1 • • f .' 1 4( r• r . . . . : .CORPORATE OFFICER SIGNATURE • • • (Faxed signatures are acceptable) • . • • . 0800016707' . 1 . • City �of� IN ='� . _ 7 1.446 1819 Farn 411;,i(likT017 'nm —Suite LC 1a Omaha, Nebraska 68183-0112 Buster Brown (402) 444-5550 City Clerk FAX (402) 444-5263 4b41.Fp FEBRvt'� • September 16, 2008 Hy-Vee, Inc. Application to appoint Scott Schlatter Dba"Hy-Vee Drugstore" manager of your present Class "C" 8404 North 30th Street Liquor License Omaha, NE 68112 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 September 30, 2008 . 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 County of The foregoing instrument was acknowledged before me this age by 2eg0Aali a telle2. date name of person acknowledged /J k/"Yh Affix Se. KiViN J. GOURKA Notary Pu c signature ; $lot•Gof Nab Notary MY CommIu4on EXDU.1 Fab 10 21109 i g— —_ a li a tlf s ►'-ieY t pab 4. a e a Niel:-• a oV a e e a lift, 6✓'t iTh ao a "", ea at-i "�- a o a_Sge.wore, - o as�. r as � a to ��e s•a e ..�`�pr o a.. ��� � �� a eerie e� �`10 0���6ajo��t����of�� •��e�a� 3��k '.�-'? ��a,: .. . !. w..a4--.s.-x-- , -*-- -.�.'-e�Y; r-: , "r_'.-4-- x-- .n`'.s. 54 - ,s5;3 t ... 3�% Ca aii'ea- o i6ai� • AT • »°..:.' a t.�a.�+l' o��w a t ?_ .. �";' 3.;� ,_n.,rz�s fir-, = ° r &o f SC hk f Si_ attire of individual involved with application Printed name of applying individual (Spouse of individual li ed above) d\k} State of 4d-'Ut, County of o-vcaA,_/t The foregoing instrument rwas acknowledged before me this j .gfr by Gct SG�1 LGTr4ate n name of person acknowledged 7 'vi �''oi Affix Seal ; • s Notary Publigna///tur��e\\JJ 4 GOURKA pWroJ. Noj ary 1 Mat*of Nf►bfa*O ...as ab 10. 2009 In compliance with the ADA,this spousal affidavit of non participation is available in other fo A ten day advance period is requested in writing to produce the alternate format. , FORM 35-4178 Revised 1/2008 6,2011 • In compliance with the ADA,this manager insert form 3c is available in other formats for persons with disabilities. • A ten day advance period is required in writing to produce the alternate format. - • . Revised 5/I007 re acceptable) 0800016708 . .9i::�:5•. _3<,. 3'.�j:"�,... �:.,;� 1.+. tk, X:..y,!, f..,. _Si?.:: Cr•d"�rk.>•,: +d.:•_._e.u ...c'.'.:;5'r.•..:...{^f:�sei:.F.:i^...:a...,...J.e•�,,. �•"+L7J.`,1>u,iiv.F:h.,dY:sY R-`:.•irv.ne. ,r. i-.i:..7+:7 ....._3•kti:+a•:' o:ka$a�'},.n�w<......<.. :'S`L"�!•.tew.,.....s;' �a�i :.-i�1'X'.:;,.'i..n.s.:...k3,=a.L,..1,1 • • f .' 1 4( r• r . . . . : .CORPORATE OFFICER SIGNATURE • • • (Faxed signatures are acceptable) • . • • . 0800016707' . 1 . �„{AHA, N 44, Ci4, t o Omaha Ne bras a : �1 I' -,,p c., ....,igat, 1819 Farnam Suite LC 1 �� rAel.ri*4 IN,EriOmaha, Nebraska 68183-0112 0��.� a 7 Buster Brown (402) 444-5550 0 ^'' City Clerk FAX (402) 444-5263 O'�, FEaR��44 September 16, 2008 Scott Schlatter Application to be appointed manager of the present 3325 Longview Court Class "C"; Class "C/K" and Package Liquor Licenses Lincoln,NE 68506 for Hy-Vee, Inc., see attached list 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 September 30, 2008 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 date name of person acknowledged /J k/"Yh Affix Se. KiViN J. GOURKA Notary Pu c signature ; $lot•Gof Nab Notary MY CommIu4on EXDU.1 Fab 10 21109 i g— —_ a li a tlf s ►'-ieY t pab 4. a e a Niel:-• a oV a e e a lift, 6✓'t iTh ao a "", ea at-i "�- a o a_Sge.wore, - o as�. r as � a to ��e s•a e ..�`�pr o a.. ��� � �� a eerie e� �`10 0���6ajo��t����of�� •��e�a� 3��k '.�-'? ��a,: .. . !. w..a4--.s.-x-- , -*-- -.�.'-e�Y; r-: , "r_'.-4-- x-- .n`'.s. 54 - ,s5;3 t ... 3�% Ca aii'ea- o i6ai� • AT • »°..:.' a t.�a.�+l' o��w a t ?_ .. �";' 3.;� ,_n.,rz�s fir-, = ° r &o f SC hk f Si_ attire of individual involved with application Printed name of applying individual (Spouse of individual li ed above) d\k} State of 4d-'Ut, County of o-vcaA,_/t The foregoing instrument rwas acknowledged before me this j .gfr by Gct SG�1 LGTr4ate n name of person acknowledged 7 'vi �''oi Affix Seal ; • s Notary Publigna///tur��e\\JJ 4 GOURKA pWroJ. Noj ary 1 Mat*of Nf►bfa*O ...as ab 10. 2009 In compliance with the ADA,this spousal affidavit of non participation is available in other fo A ten day advance period is requested in writing to produce the alternate format. , FORM 35-4178 Revised 1/2008 6,2011 • In compliance with the ADA,this manager insert form 3c is available in other formats for persons with disabilities. • A ten day advance period is required in writing to produce the alternate format. - • . Revised 5/I007 re acceptable) 0800016708 . .9i::�:5•. _3<,. 3'.�j:"�,... �:.,;� 1.+. tk, X:..y,!, f..,. _Si?.:: Cr•d"�rk.>•,: +d.:•_._e.u ...c'.'.:;5'r.•..:...{^f:�sei:.F.:i^...:a...,...J.e•�,,. �•"+L7J.`,1>u,iiv.F:h.,dY:sY R-`:.•irv.ne. ,r. i-.i:..7+:7 ....._3•kti:+a•:' o:ka$a�'},.n�w<......<.. :'S`L"�!•.tew.,.....s;' �a�i :.-i�1'X'.:;,.'i..n.s.:...k3,=a.L,..1,1 • • f .' 1 4( r• r . . . . : .CORPORATE OFFICER SIGNATURE • • • (Faxed signatures are acceptable) • . • • . 0800016707' . 1 . HY-VEE STORES CLASS "C" LIQUOR LICENSES - 10 HY-VEE, INC 8404 NO 30TH ST DBA HY-VEE DRUGSTORE HY-VEE INC. 5150 CENTER ST DBA HY VEE FOOD STORE#1 HY-VEE INC 3405 OAKVIEW DR DBA HY-VEE#2 CATERING LICENSE HY VEE INC 8809 WEST CENTER RD DBA HY VEE#3 CATERING LICENSE HY VEE INC 10808 FORT STREET DBAHYVEE#4 HY VEE INC 7910 CASS ST DBA HY VEE #5 HY-VEE INC 9707 Q STREET DBA HY-VEE FOOD STORE#6 HY-VEE INC. 3505 L ST STOCKYARD PLAZA DBA HY VEE #7 HY VEE INC 747 NORTH 132ND ST DBA HY VEE#8 HY-VEE INC 10120 MAPLE STREET DBA HY-VEE WINE AND SPIRITS#4 CATERING LICENSE PACKAGE LIQUOR LICENSES - 4 HY-VEE, INC 5102 CENTER STREET DBA HY-VEE GAS (#1) HY-VEE, INC 8829 WEST CENTER ROAD DBA HY-VEE GAS#3 HY-VEE, INC 9601 Q STREET DBA HY-VEE GAS#6 HY-VEE, INC 749 NORTH 132ND STREET DBA HY-VEE GAS (#8) 9 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 date name of person acknowledged /J k/"Yh Affix Se. KiViN J. GOURKA Notary Pu c signature ; $lot•Gof Nab Notary MY CommIu4on EXDU.1 Fab 10 21109 i g— —_ a li a tlf s ►'-ieY t pab 4. a e a Niel:-• a oV a e e a lift, 6✓'t iTh ao a "", ea at-i "�- a o a_Sge.wore, - o as�. r as � a to ��e s•a e ..�`�pr o a.. ��� � �� a eerie e� �`10 0���6ajo��t����of�� •��e�a� 3��k '.�-'? ��a,: .. . !. w..a4--.s.-x-- , -*-- -.�.'-e�Y; r-: , "r_'.-4-- x-- .n`'.s. 54 - ,s5;3 t ... 3�% Ca aii'ea- o i6ai� • AT • »°..:.' a t.�a.�+l' o��w a t ?_ .. �";' 3.;� ,_n.,rz�s fir-, = ° r &o f SC hk f Si_ attire of individual involved with application Printed name of applying individual (Spouse of individual li ed above) d\k} State of 4d-'Ut, County of o-vcaA,_/t The foregoing instrument rwas acknowledged before me this j .gfr by Gct SG�1 LGTr4ate n name of person acknowledged 7 'vi �''oi Affix Seal ; • s Notary Publigna///tur��e\\JJ 4 GOURKA pWroJ. Noj ary 1 Mat*of Nf►bfa*O ...as ab 10. 2009 In compliance with the ADA,this spousal affidavit of non participation is available in other fo A ten day advance period is requested in writing to produce the alternate format. , FORM 35-4178 Revised 1/2008 6,2011 • In compliance with the ADA,this manager insert form 3c is available in other formats for persons with disabilities. • A ten day advance period is required in writing to produce the alternate format. - • . Revised 5/I007 re acceptable) 0800016708 . .9i::�:5•. _3<,. 3'.�j:"�,... �:.,;� 1.+. tk, X:..y,!, f..,. _Si?.:: Cr•d"�rk.>•,: +d.:•_._e.u ...c'.'.:;5'r.•..:...{^f:�sei:.F.:i^...:a...,...J.e•�,,. �•"+L7J.`,1>u,iiv.F:h.,dY:sY R-`:.•irv.ne. ,r. i-.i:..7+:7 ....._3•kti:+a•:' o:ka$a�'},.n�w<......<.. :'S`L"�!•.tew.,.....s;' �a�i :.-i�1'X'.:;,.'i..n.s.:...k3,=a.L,..1,1 • • f .' 1 4( r• r . . . . : .CORPORATE OFFICER SIGNATURE • • • (Faxed signatures are acceptable) • . • • . 0800016707' . 1 . p I g k P n $ 2. 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