Loading...
RES 2008-1346 - Appoint Scott Schlatter manager of Hy-Vee Gas #8 • STATE OF NEBRASKA � Dave Heineman ''',� , P, Y NEBRASKA LIQUOR CONTROL COMMISSION .a s Governor ~ar. ?t Hobert B. Rupe 111j\\ • ' ' Executive Director 301 Centennial Mall South,5th Floor iv P.O.Box 95046 t*.:`;H; `�� .'L. Lincoln,Nebraska 68509-5046 Phone(402)471-2571 September 2, 2008 Fax(402)471-2814 TRS USER 800 833-7352(Ti'Y) web address:http://www.lcc.ne.gov/ City Clerk of Omahas ci( 1819 Farnam LC1NE 68183a-S 4' Omaha, CO 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, Jackie B. Matulka Licensing Division Enclosure • Rhonda R.Flower Bob Logsdon • Robert Batt Commissioner Chairman Commissoner An Equal Opportunity/Affirmative Action Employer Printed with soy ink on recycled paper • tots of NMbroska I My Commission Extra F•b Q. 2n00; sisilsossionr - - -- -- -40'41Pollt AIL 1 mere e�'7 e r I' it Ie ••-'''.4. -.. s "' a— e @'',7t� t e��i e 0 miliTe� c3vt@ i @ar��e1o'iLY re0 )� 'Fn 73-, 0.0 @a e e woe a teYfi �ii&-tit e.0 o e o f Pi e r �I,.�o ei ae 'i�arfir o11e i Sod@ E@�0��OfeH� k a i�?. W 1gp - 0 @@100t A�`�t"GS�@0 fi. 1 �-t'�el0 Qr ©�..��� `- -y ,,? Si: attire of individual involved with application Printed name of applying individual (Spouse of individual li ted above) 1\t' -} State of County of The foregoing instrument was acknowledged before me this g ID'gig' by 5 GolT 5CJI LaTJ-€<. date name of person acknowledged ��itM'►I Acwil_, Affix Seal ralhodlimilandlibudhuidhmio, KEVIN J. GOURKA Notary Publ' signature 4onorol Notary ` 1 Oat*of PNbroska . , My CORIfrrissiott Expires Fob 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 SG/In LaiTt€'.- date name of person acknowledged �� ` Affix Seal — V ilM�►1 l OWN J.GOMA I ' si Notary Publgnature Oral Notary 1 State of Nebraska ( n+msa s Fab 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 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 . • MANAGER APPLICATION Office Use �I INSERT-FORM 3c RECEIVED NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH AUG 2 9 2008 PO BOX 95046 LINCOLN,NE 68509-5046 PHONE:(402)471-2571 NEBRASKA LIQUOR FAX:(402)471-2814 Website:www.lcc.ne.gov CONTROL. COMMISSION 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) 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 0 i-F pl E n!0 7 0 Oj'"'• s- a0 0 0,.• -.£;. 1} Name of Corporation/LLC: Hy-Vee, Inc ;.�. .. �_- __ Premise License Number:66730 Premise Trade Name/DBA:Hy-Vee Gas 8 Premise Street Address:749 N. 132nd St. City:Omaha State: NE Zip Code:68154 Premise Phone Number:(402)496-8901 } F gi� i o Orr. tte ��iF iiLK'� 'N� �de�Ii� �C���d����>i i�).� o�'('—� iiT ii itgeR.eQOIIth 1. ii11' CORPORATE OFFICER SIGNATURE (Faxed signatures are acceptable) K VIN REEVE ASS'PACE PRESIDENT., T Oi tFR Rhonda R.Flower Bob Logsdon • Robert Batt Commissioner Chairman Commissoner An Equal Opportunity/Affirmative Action Employer Printed with soy ink on recycled paper • tots of NMbroska I My Commission Extra F•b Q. 2n00; sisilsossionr - - -- -- -40'41Pollt AIL 1 mere e�'7 e r I' it Ie ••-'''.4. -.. s "' a— e @'',7t� t e��i e 0 miliTe� c3vt@ i @ar��e1o'iLY re0 )� 'Fn 73-, 0.0 @a e e woe a teYfi �ii&-tit e.0 o e o f Pi e r �I,.�o ei ae 'i�arfir o11e i Sod@ E@�0��OfeH� k a i�?. W 1gp - 0 @@100t A�`�t"GS�@0 fi. 1 �-t'�el0 Qr ©�..��� `- -y ,,? Si: attire of individual involved with application Printed name of applying individual (Spouse of individual li ted above) 1\t' -} State of County of The foregoing instrument was acknowledged before me this g ID'gig' by 5 GolT 5CJI LaTJ-€<. date name of person acknowledged ��itM'►I Acwil_, Affix Seal ralhodlimilandlibudhuidhmio, KEVIN J. GOURKA Notary Publ' signature 4onorol Notary ` 1 Oat*of PNbroska . , My CORIfrrissiott Expires Fob 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 SG/In LaiTt€'.- date name of person acknowledged �� ` Affix Seal — V ilM�►1 l OWN J.GOMA I ' si Notary Publgnature Oral Notary 1 State of Nebraska ( n+msa s Fab 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 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 . 4 . , q µ t V! r�9118 8 ! T,Fle 9 B! @ - fil 06�,i 5 e er o 0 01 Al e r ' , a L...d at v ..,... -q 4. s5 —x?Y-•!4�" :€ .� a°.w,3 '�1_..'Er'"— v .. '$'.�la' il.:y� r.. .� T.v:in".1A `F?' -_ .w. - .. � *wu Gender: 17 MALE 0 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.Fe4,.r^er,,,,t....-- _.fih'[ht�rrv_.=:.:w^r.,r4M,ts-.:r_v:.eir_�':-t-N eio;—.ii a 611»a'd�1lO.. spiv ore i a Y�a.e:+lr.A�OI ae oieleoe�....-. ,,........ .':*.,.,,,,. meaa4.'a«eiloomr.tocflmau o^ .i�t.,"la .aielloil�e 10i n» � !i _ _ W ✓❑YES ❑NO ..:sw,sa t'*itfva.3,..,,.h..t.1s: >w.a.. Y.x ..-m.w. N. .. ..mw,,-m.,a ..» t .-er,. . ..�. . ._..ili ...1..�. .T1n1 S n a®laelhYs.1®51 ...,�., y- ,._.. _ ,:..a.--.1,. - , a". ,:._._.L. . - t74. � .i *x r- ...as a { 3aG24 w _-,cFs. 3vTa t^ =--mrt- 1ww.fia- a� .,Lr'tt45 7 i - t, Spouses Last Name:Schlatter First Name:Deborah MI:M Social Security Number: . - Drivers License Number& State: NE Date Of Birth: I _ . - Place Of Birth:West Union, IA fdK ,1!k 1,AMPir-I-ii "rV. P_f:. _ 4.14.1.-..�*1 ikli,.rgli. 4, ,I - ,r7+. .:CV' 44" d.1.,N -Y-.-,`A` et _ r f�4���Y� lw,��'.-NM�ikilyy �l� 5 k'.�i 3'fi.t�Y2an i�tF.?S`�dtn:'�'1'.�tr'i�'�CIA Y.' Et,.sn 2 pW w�� ' _ :. c.::,....r,�.L l'_r.,r...4,14.m..ievrr ti. ....v{'+_,i;„cey^ _ 4 r -t-tu �i.i.w '�xg -4=4.0r°`.'"':=:.-.-.. fg--,SP OU 'ups'`. +'- s- - -rF,f4, 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 19 5 2000 Ralston, NE W.s - ,r.3. kx 'r ." ..,d '"Frrimss1;', �� ®',- '� u 35w � ' �.�:saas x�-.eai-.r....vv.x., . a,�K_� 5:...,k�!.:i��:_.-F .,:o-x�.;.. _� A.r_.._-_..._.:,u _. .. � � 'i::.`d'4�s,,.*. 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 FORM 35-4178 Revised 1/2008 SG/In LaiTt€'.- date name of person acknowledged �� ` Affix Seal — V ilM�►1 l OWN J.GOMA I ' si Notary Publgnature Oral Notary 1 State of Nebraska ( n+msa s Fab 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 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 . ✓ • • ' t,' .+a',?i(;; .1l1i4-.y- .3..�,. :�e;a ;� ' »E.�• S[; iIi{4.i .C3s1}. {*31'MY' a sal r. __ __ .� • 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) OYES 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$38.00 per person) ©YES ONO Ta t^ =--mrt- 1ww.fia- a� .,Lr'tt45 7 i - t, Spouses Last Name:Schlatter First Name:Deborah MI:M Social Security Number: . - Drivers License Number& State: NE Date Of Birth: I _ . - Place Of Birth:West Union, IA fdK ,1!k 1,AMPir-I-ii "rV. P_f:. _ 4.14.1.-..�*1 ikli,.rgli. 4, ,I - ,r7+. .:CV' 44" d.1.,N -Y-.-,`A` et _ r f�4���Y� lw,��'.-NM�ikilyy �l� 5 k'.�i 3'fi.t�Y2an i�tF.?S`�dtn:'�'1'.�tr'i�'�CIA Y.' Et,.sn 2 pW w�� ' _ :. c.::,....r,�.L l'_r.,r...4,14.m..ievrr ti. ....v{'+_,i;„cey^ _ 4 r -t-tu �i.i.w '�xg -4=4.0r°`.'"':=:.-.-.. fg--,SP OU 'ups'`. +'- s- - -rF,f4, CITY&STATE YEAR CITY&STATE YEAR FROM TO FROM TO 3325 Longview Ct., Lincoln, NE 2007 Curr 3325 Longview Ct., Lincoln, NE 2007 Curr 5932 S 81st St, Lincoln, NE 2003 2007 5932 S 81st St, Lincoln, NE 2003 2007 Lee's Summit, MO 2000 2003 Lee's Summit, MO 2000 2003 Ralston, NE 1995 2000 19 5 2000 Ralston, NE W.s - ,r.3. kx 'r ." ..,d '"Frrimss1;', �� ®',- '� u 35w � ' �.�:saas x�-.eai-.r....vv.x., . a,�K_� 5:...,k�!.:i��:_.-F .,:o-x�.;.. _� A.r_.._-_..._.:,u _. .. � � 'i::.`d'4�s,,.*. YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER FROM TO 1990 Curr Hy-Vee, Inc Pat Hensley 515-267-2800 1988 1990 Milwaukee Biscut Co Rich Baker N/A FORM 35-4178 Revised 1/2008 SG/In LaiTt€'.- date name of person acknowledged �� ` Affix Seal — V ilM�►1 l OWN J.GOMA I ' si Notary Publgnature Oral Notary 1 State of Nebraska ( n+msa s Fab 10. 2009 In compliance with the ADA,this spousal affidavit of non participation is available in other fo A ten day advance period is requested in writing to produce the alternate format FORM 35-4178 Revised 1/2008 0800016708 . .9i::�:5•. _3<,. 3'.�j:"�,... �:.,;� 1.+. tk, X:..y,!, f..,. _Si?.:: Cr•d"�rk.>•,: +d.:•_._e.u ...c'.'.:;5'r.•..:...{^f:�sei:.F.:i^...:a...,...J.e•�,,. �•"+L7J.`,1>u,iiv.F:h.,dY:sY R-`:.•irv.ne. ,r. i-.i:..7+:7 ....._3•kti:+a•:' o:ka$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 . -ec-a. ..: .? s_=:- :.w3 — �,--. rr r _ .. 7 - _ -. ..- .,, _ 4 Y "'xG-- --- 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. 1 / / _ Signature of Manager Applicant Signature of Spouse State of Nebraska County of County of The foregoing 'nstru ent was acknowledged before The foregoin ins ment was acknowledged before me this g ia.R $ by me this �= by � NotaryPublic nature 4/-1/v‘ -J/MA-10- 74."-kr -AJ, 1 NdPublibliai nature tary g • i ix e• -er Affix Here KEVIN J. KEVIN J. GOURKA GeneralGNofary General Notary MY Cmlulon ExpOf Uea FeD 10, MY Stateto of pines Feb2009 ComnHuion Expires Fb 10 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 1st St, Lincoln, NE 2003 2007 Lee's Summit, MO 2000 2003 Lee's Summit, MO 2000 2003 Ralston, NE 1995 2000 19 5 2000 Ralston, NE W.s - ,r.3. kx 'r ." ..,d '"Frrimss1;', �� ®',- '� u 35w � ' �.�:saas x�-.eai-.r....vv.x., . a,�K_� 5:...,k�!.:i��:_.-F .,:o-x�.;.. _� A.r_.._-_..._.:,u _. .. � � 'i::.`d'4�s,,.*. 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 FORM 35-4178 Revised 1/2008 SG/In LaiTt€'.- date name of person acknowledged �� ` Affix Seal — V ilM�►1 l OWN J.GOMA I ' si Notary Publgnature Oral Notary 1 State of Nebraska ( n+msa s Fab 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 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$a�'},.n�w<......<.. :'S`L"�!•.tew.,.....s;' �a�i :.-i�1'X'.:;,.'i..n.s.:...k3,=a.L,..1,1 • • f .' 1 4( r• r . . . . : .CORPORATE OFFICER SIGNATURE • • • (Faxed signatures are acceptable) • . • • . 0800016707' . 1 . r --- [5C1`to_,er- SPOUSAL AFFIDAVIT OF Office Use NON PARTICIPATION INSERT RECEIVED NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH PO BOX 95046 AUG 2 9 2008 LINCOLN,NE 68509-5046 PHONE:(402)471-2571 FAX:(402)471-2814 NFRRASKA LIQUOR Website: www.lcc.ne Qov T� ��� h�g Y ., A. 3 l �� ..,.. Qiw«;, •.•-�iWtrr f'S..'t' 0 1 It.- @ Ol rA, ' 1�1 ; a e ..L` e.a.-.....-n. ,ary a llY' ' T 1 t) so1 1 IQ7 a)®i1,• a {411 1m / @ 3 r - t --- .'. - ?-r3�c • .�},� •-:v:c'=s. +a, sit a CY Y o th iqu V E 6 1 1'0 a"ii ¢tAt .- a fit_ ", 11ii- r .0 1 e 1 erlltlb It 0 Z/ / ® 81'r- 0 ' ;--r, F- ,... hc'I7 _ 167.1 L. V Z0'"- 0 1 4. r K 1 �e1 a t e r 1 � My� /-': Te: Lit i 01 :GCS•Il g---------,-. ..____--:-. ----, r Iten e e_Vu�rb 1 a a� 1 i! fi a a a/ . /1 0 B6zii. a 6: i k.$ 1t151s 0 -1 1 0, 1 a o' ® !_ IFlilsa U,ME§-. 2,ea a �aW@„llo_a`. �[ � it os fga c°'�,.- I e 0 -o it 1a ornBo0n 0' aBy_Gfl O1SllLcs _it,_ocees t : TT .,,�F �,•-.� yam-" F. iG� C. 0 a 1 ^.".'1 ..-z_ - M Ya,- _ rz._ ._. -. - -tea T�s` s' =�^-` 5:�,. /f%�4 1hse,bbrah Sch la_44.E ( Signature of spouse asking for waiver Printed name of spouse asking for waiver (Spouse of individual� � listed below) State of L�Xt� 1 \\I County of The foregoing instrument was acknowledged before me this g �.g 8 by 2e.$O/Zull SG )Lgtre.R. date name of person acknowledged Affix Sel KEVIN J. GOURKA ` Gor�orat Notary 1 otary Pu c signature 1 State of Nabtasica I Mr Commission E*Dttot fob IQ, 2n09 1 a, ,�:... _,,.1. .. X 't'�z dE a1 q � `S fiL�.tl 2 E:..� 1 @`v 4'1• algal 1@ b r,; 01 O y�-ql.1�[ '4/0 1. 'B nT 9�� u i J { 1 ® ,-;, iY- 11 1—.. ll_ ..., # �-�,,„,,,b��Y, K,,/a ae .11 1 G1' 1 14. 6 41 , 0 1 0.--,---a--;-,-------:,.! 0 / i- Ga...0.'.� ��sel 41,..�e81 . a�1...R.t.-s,�C i teY .n„a ,.., y I t r 5 &. ^„F ,T"' �. �L.:w. .lay(-N aY;i.: -i-. .,� @ oellml't.X o 1�elY v. � � P> ��' it�YI�w..y.. �t -/�..,saYt`� - 3a.� '�",,,� .�, a:r,,.. ., •��.� . 41, air Si. ature of individual involved with application Printed name of applying individual (Spouse of individual li ted above) d\&"} State of /UAL County of The foregoing instrument/ was acknowledged before me this jg/g' by SSGc ► ' SGn Larre4 date name of person acknowledged C /�v) nA„...1- Affix Seal 1 KEVIN J.GOURKA 1 Notary Publ. signature Gonorot Notary 0 Scats of Nibraska tif.INr7es cob 10.2009 • In compliance with the ADA,this spousal affidavit of non participation is available in other fo A ten day advance period is requested in writing to produce the alternate format. FORM 35-4178 Revised 1/2008 3<,. 3'.�j:"�,... �:.,;� 1.+. tk, X:..y,!, f..,. _Si?.:: Cr•d"�rk.>•,: +d.:•_._e.u ...c'.'.:;5'r.•..:...{^f:�sei:.F.:i^...:a...,...J.e•�,,. �•"+L7J.`,1>u,iiv.F:h.,dY:sY R-`:.•irv.ne. ,r. i-.i:..7+:7 ....._3•kti:+a•:' o:ka$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 . OMp.HA, CityofOmaha, Ne bras a �,° 1'°' �� 1819 Farnam Suite- 1 2VO;fillgriAla i. -'` LC n �' it '^ Omaha, Nebraska 68183-0112 0' - Buster Brown (402) 444-5550 -PA 1,' City Clerk FAX (402) 444-5263 O� Ep FEBR�r�� September 16, 2008 Hy-Vee, Inc. Application to appoint Scott Schlatter Dba"Hy-Vee Gas (#8)" manager of your present Package 749 North 132nd Street Liquor License Omaha,NE 68154 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 302 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 M Ya,- _ rz._ ._. -. - -tea T�s` s' =�^-` 5:�,. /f%�4 1hse,bbrah Sch la_44.E ( Signature of spouse asking for waiver Printed name of spouse asking for waiver (Spouse of individual� � listed below) State of L�Xt� 1 \\I County of The foregoing instrument was acknowledged before me this g �.g 8 by 2e.$O/Zull SG )Lgtre.R. date name of person acknowledged Affix Sel KEVIN J. GOURKA ` Gor�orat Notary 1 otary Pu c signature 1 State of Nabtasica I Mr Commission E*Dttot fob IQ, 2n09 1 a, ,�:... _,,.1. .. X 't'�z dE a1 q � `S fiL�.tl 2 E:..� 1 @`v 4'1• algal 1@ b r,; 01 O y�-ql.1�[ '4/0 1. 'B nT 9�� u i J { 1 ® ,-;, iY- 11 1—.. ll_ ..., # �-�,,„,,,b��Y, K,,/a ae .11 1 G1' 1 14. 6 41 , 0 1 0.--,---a--;-,-------:,.! 0 / i- Ga...0.'.� ��sel 41,..�e81 . a�1...R.t.-s,�C i teY .n„a ,.., y I t r 5 &. ^„F ,T"' �. �L.:w. .lay(-N aY;i.: -i-. .,� @ oellml't.X o 1�elY v. � � P> ��' it�YI�w..y.. �t -/�..,saYt`� - 3a.� '�",,,� .�, a:r,,.. ., •��.� . 41, air Si. ature of individual involved with application Printed name of applying individual (Spouse of individual li ted above) d\&"} State of /UAL County of The foregoing instrument/ was acknowledged before me this jg/g' by SSGc ► ' SGn Larre4 date name of person acknowledged C /�v) nA„...1- Affix Seal 1 KEVIN J.GOURKA 1 Notary Publ. signature Gonorot Notary 0 Scats of Nibraska tif.INr7es cob 10.2009 • In compliance with the ADA,this spousal affidavit of non participation is available in other fo A ten day advance period is requested in writing to produce the alternate format. FORM 35-4178 Revised 1/2008 3<,. 3'.�j:"�,... �:.,;� 1.+. tk, X:..y,!, f..,. _Si?.:: Cr•d"�rk.>•,: +d.:•_._e.u ...c'.'.:;5'r.•..:...{^f:�sei:.F.:i^...:a...,...J.e•�,,. �•"+L7J.`,1>u,iiv.F:h.,dY:sY R-`:.•irv.ne. ,r. i-.i:..7+:7 ....._3•kti:+a•:' o:ka$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 NF804 Ci t o Omaha Nebras a (5cti �1 I -y ,mow7 • 1819 Farnam— Suite LC 1 fitr,),: A�`� n Omaha, Nebraska 68183-0112 0 ,� t;.� Buster Brown (402) 444-5550 � ry City Clerk FAX (402) 444-5263 o�'��D FEaR3�'�-� 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 ' =�^-` 5:�,. /f%�4 1hse,bbrah Sch la_44.E ( Signature of spouse asking for waiver Printed name of spouse asking for waiver (Spouse of individual� � listed below) State of L�Xt� 1 \\I County of The foregoing instrument was acknowledged before me this g �.g 8 by 2e.$O/Zull SG )Lgtre.R. date name of person acknowledged Affix Sel KEVIN J. GOURKA ` Gor�orat Notary 1 otary Pu c signature 1 State of Nabtasica I Mr Commission E*Dttot fob IQ, 2n09 1 a, ,�:... _,,.1. .. X 't'�z dE a1 q � `S fiL�.tl 2 E:..� 1 @`v 4'1• algal 1@ b r,; 01 O y�-ql.1�[ '4/0 1. 'B nT 9�� u i J { 1 ® ,-;, iY- 11 1—.. ll_ ..., # �-�,,„,,,b��Y, K,,/a ae .11 1 G1' 1 14. 6 41 , 0 1 0.--,---a--;-,-------:,.! 0 / i- Ga...0.'.� ��sel 41,..�e81 . a�1...R.t.-s,�C i teY .n„a ,.., y I t r 5 &. ^„F ,T"' �. �L.:w. .lay(-N aY;i.: -i-. .,� @ oellml't.X o 1�elY v. � � P> ��' it�YI�w..y.. �t -/�..,saYt`� - 3a.� '�",,,� .�, a:r,,.. ., •��.� . 41, air Si. ature of individual involved with application Printed name of applying individual (Spouse of individual li ted above) d\&"} State of /UAL County of The foregoing instrument/ was acknowledged before me this jg/g' by SSGc ► ' SGn Larre4 date name of person acknowledged C /�v) nA„...1- Affix Seal 1 KEVIN J.GOURKA 1 Notary Publ. signature Gonorot Notary 0 Scats of Nibraska tif.INr7es cob 10.2009 • In compliance with the ADA,this spousal affidavit of non participation is available in other fo A ten day advance period is requested in writing to produce the alternate format. FORM 35-4178 Revised 1/2008 3<,. 3'.�j:"�,... �:.,;� 1.+. tk, X:..y,!, f..,. _Si?.:: Cr•d"�rk.>•,: +d.:•_._e.u ...c'.'.:;5'r.•..:...{^f:�sei:.F.:i^...:a...,...J.e•�,,. �•"+L7J.`,1>u,iiv.F:h.,dY:sY R-`:.•irv.ne. ,r. i-.i:..7+:7 ....._3•kti:+a•:' o:ka$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 DBA HYVEE#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) 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 ' =�^-` 5:�,. /f%�4 1hse,bbrah Sch la_44.E ( Signature of spouse asking for waiver Printed name of spouse asking for waiver (Spouse of individual� � listed below) State of L�Xt� 1 \\I County of The foregoing instrument was acknowledged before me this g �.g 8 by 2e.$O/Zull SG )Lgtre.R. date name of person acknowledged Affix Sel KEVIN J. GOURKA ` Gor�orat Notary 1 otary Pu c signature 1 State of Nabtasica I Mr Commission E*Dttot fob IQ, 2n09 1 a, ,�:... _,,.1. .. X 't'�z dE a1 q � `S fiL�.tl 2 E:..� 1 @`v 4'1• algal 1@ b r,; 01 O y�-ql.1�[ '4/0 1. 'B nT 9�� u i J { 1 ® ,-;, iY- 11 1—.. ll_ ..., # �-�,,„,,,b��Y, K,,/a ae .11 1 G1' 1 14. 6 41 , 0 1 0.--,---a--;-,-------:,.! 0 / i- Ga...0.'.� ��sel 41,..�e81 . a�1...R.t.-s,�C i teY .n„a ,.., y I t r 5 &. ^„F ,T"' �. �L.:w. .lay(-N aY;i.: -i-. .,� @ oellml't.X o 1�elY v. � � P> ��' it�YI�w..y.. �t -/�..,saYt`� - 3a.� '�",,,� .�, a:r,,.. ., •��.� . 41, air Si. ature of individual involved with application Printed name of applying individual (Spouse of individual li ted above) d\&"} State of /UAL County of The foregoing instrument/ was acknowledged before me this jg/g' by SSGc ► ' SGn Larre4 date name of person acknowledged C /�v) nA„...1- Affix Seal 1 KEVIN J.GOURKA 1 Notary Publ. signature Gonorot Notary 0 Scats of Nibraska tif.INr7es cob 10.2009 • In compliance with the ADA,this spousal affidavit of non participation is available in other fo A ten day advance period is requested in writing to produce the alternate format. FORM 35-4178 Revised 1/2008 3<,. 3'.�j:"�,... �:.,;� 1.+. tk, X:..y,!, f..,. _Si?.:: Cr•d"�rk.>•,: +d.:•_._e.u ...c'.'.:;5'r.•..:...{^f:�sei:.F.:i^...:a...,...J.e•�,,. �•"+L7J.`,1>u,iiv.F:h.,dY:sY R-`:.•irv.ne. ,r. i-.i:..7+:7 ....._3•kti:+a•:' o:ka$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 . v f � � �.� zx z :� � � � � � o I tii U.) o d o 0 a p p n n i ~ Co Po cDCD A) � x V • CD po CCDD BCD UQ ,�.r a iC 1-11 0 r CD g x o C V Cocp 0 a G I � \ 2 � / i 9 2 .. CS \ \ k. 13, a cn kA C'