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RES 2008-1455 - Appoint Willie Blake manager of American Legion C Williamson 30 w:•`• ^4 STATE OF NEBRASKA ;fi e:. t /._ .;a. '4jt d!" ,1 l ;k Dave Heineman NEBRASKA LIQUOR CONTROL COMMISSION 4 NTT ^ p.•: '' Governor Hobert B. Rupe ector `qR \�'gb 301 Centennial Mall South, 5 Executive DthrFloor P.O.Box 95046 Lincoln,Nebraska 68509-5046 Phone(402)471-2571 Fax(402)471-2814 TRS USER 800 833-7352(TTY) September 30, 2008 web address:http://www.lcc.ne.gov/ CD CO OMAHA CITY CLERK (7) © ;"ti 1819 FARNAM STREET LC-1 x OMAHA NE 68183 z 1. "1 In Re: AMERICAN LEGION POST #30 DBA AMERICAN LEGION POST#30 License # C-01253 Dear Clerk: • Enclosed is a copy of a manager application for WILLIE BLAKE in connection AMERICAN LEGION POST #30 located at 1817 N 33DR STREET OMAHA NE 68111, Liquor License #IC-01253. Please present this application for manager to your City/Village Council or County Commissioners and send us the results of their action. Sincerely, NEBRASKA LIQUOR CONTROL COMMISSION c�-- /' • j( `� a)L9-6Q--L-C' Tami Applebee Licensing Division • encl. 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 ,^ vt...6L, NEBRASKA LIQUOR CONTROL COMMISSION 301PO CENTENNIAL MALL SOUTH PIECE' LI BOX 9,NE a _ 3,.OVE LINCOLN NE 68509-5046 �? L•: .. PHONE:(402)471-2571 FAX:(402)471-2814 NEBRASKA LIQUOR Website:www.lcc.ne.eov CONTROL COMMISSION JUL 2 2:2009 NEBRASKA u Corporate manager,including their spouse,are required to adhere to the following requirements CoNrpOL COMM SS pN 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 l 4) Must submit their fingerprints(2 cards per person) cJ 5) Must be 21 years of age or older 1....� 6) Applicant may be required to take training course • L � a x ry r r sx• Pz �rv� r r 4Wn n a :.GPkd� *sit% . ._... ax Name of Corporation/LLC: is/CON , ur C '� ' a Y a c aar zaxr �ni * " a iy x rir c c'�r asa; t t b s � � :.:�: ,cn�1 . 'g�p�,i. z^i a. '" s'* v' ur r � rAr„ �.7'.y G & n atwr ...re rd»�ka,'`" >• �i-�' ^�'. .I�.»sY " ^w�. , '. '"r tet a x Premise License Number: . 6- U I a 53 Premise Trade Name/DBA:-& 4/060 e- Premise Street Address: N/7 N ,? e g City: ©tAuth,a State: N Zip Code: Fit Premise Phone Number: 40 / 46, a t 'ad r 'p°Lx n{htr�:+�-WaT„�1��. i1"1f S ,�n ks- :,rrcc.c� �• � x •i .ra; - 9 $F 0t•*&1 t d , a '. rt a. ` �;i��F CiU� _ - i f i 0800021656 ,Q, Cott ��er- CORPORATE OFFICER.SIGNATURE (Faxed signatures are acceptable) ''.r •'Y�r'. r -.+»... "F-±-�f:1t*,- nil"-7"1.�s"P+,�;.'74,-,t^ wt�try "�£: 'T+ -'S[`4c 11.- ' •1.='rr ' iic MrS ,3"'''�i-w+rfxi�:j} t. A Ia is': a •,p ; ID t1 . c* a. • n :� l r Ir e' r�"d ' =- f } }M . !! ...&;;,.-.-- .. , .i,'7` ,' ..N. 1:'-X •.- - t eatI n ..•L'...'ii t`e: _.=..ems-.' . t. , :::, ..__4_' :t..iv ,- G r.'�c. Gender:. MALE 0 FEMALE • ALast Name: g.1 0 IC First Name: L MI: Home Address(include PO Box if applicable): 140! 7 0 10 `1 5) • City: pry)+9 r- State: k.)L. Zip Code: &0 f eo I Home Phone Number: Yo a � 3 Y9 0(3 r Business Phone Number: you 55& aa21 Social Security Number: _ Drivers:License Number State:Ng" - . t Date Of Birth: Place Of Birth: 0 /9 ti re +7) 0 H i ��'��� A � "�Y�'���_ j��� `-� 8 �• 4 `�.nx=���'�a� ��._ 'fir. ''7,�arx�Y �•-r� �i'i: .��7"� .�'". . .SEr ❑YES NO 749,.1'-P6:t•- ..1.,..1—.ZY ,-rig,`,.4 1_. t`.y: „ ,i LTA _-,-_ti'e 4 ,.., 5ay7. ', rti` 7 L' *Lv �` +s` tir J i7 liJl •t�v'K ,�;,( ..` " 1.�a p s r k i z r Spouses Last Name: First Name: MI: • Social Security Number: r• Drivers License Number&State: • Date Of Birth: Place Of Birth: li!f t{- +-, *4tw,;I}y ti 4:f*. If'+i r.,Y i v ..rt.H...... ,, k _44,„ -0., -',4.. v i, . -;.4---a r ,2-ii. r i .X,';r c ro*Y- ,--f G` 4. Y . (igr ltivtu: sw c� wit. - 't+rt�.at � 1 •?.� a1- �* 't rraj �f � � � j Ii f n. " J ^ "_. St 33T �t, t �,. k.Ix�rs•. ? e 1 "R" ,re pt, y .,. T Aj f z iz ■a, -` � " ". ^4' ¢ r ,,l:g 1- 1�;, s 1 .tr •L . — • CY C,=:t .E ( I? k.a vr-ry�l � 4 F'v4 CITY&STATE YEAR CITY&STATE YEAR FROM TO FROG' TO Ori 0 h4, lug L' 1 '1 fr4k.f • r� .'r-`7,�7''7'i''10R z t7 '7t�'�=y{. , 07: V `6 . 6,� 4 a r• i ^r .a p3—,11 x s d . YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER FROM TO Ili(i Q&eicKt 001A31►9s Cow-,#. Cdrete__iians tlttL (.,.3; 0- `ice /YY7yoo 111a 11fk Orrlitb, arrecldo„L GTrL 6c r i(K A- 102 515 3913 ,� -_'r S•k.w '"" '�cr�. } Y-4 W �� � r S^'7�w �'rr".:51. �� • «.—a�...x�'..�,— tr '� e ti: tlMx'"z�- w .� n' �tt � , �y > �arY�.. ry7 �« .d.� _�u'vlt r iew an g xg� liS 'E7r,.. �� ", ,�"° : s,o� +, ., t� � t 4 nF 3k a 4.i t� t" .I-. ....it.^K.2 t kf�i*� G�4,.,•w = ,S—� ' V wt+r�t� y��i,v. ri '? „� .... s '4 ttv ih �kt.. ,Sv 2i4 :gym.-. C'h5+i m• 'roIC ,7r. taxi . � � � � r 5 � � �� + ` -ram " kk. • 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. DYES 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 name of the premise. DYES *NO 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)` KiESO is 1 y .,. T Aj f z iz ■a, -` � " ". ^4' ¢ r ,,l:g 1- 1�;, s 1 .tr •L . — • CY C,=:t .E ( I? k.a vr-ry�l � 4 F'v4 CITY&STATE YEAR CITY&STATE YEAR FROM TO FROG' TO Ori 0 h4, lug L' 1 '1 fr4k.f • r� .'r-`7,�7''7'i''10R z t7 '7t�'�=y{. , 07: V `6 . 6,� 4 a r• i ^r .a p3—,11 x s d . YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER FROM TO Ili(i Q&eicKt 001A31►9s Cow-,#. Cdrete__iians tlttL (.,.3; 0- `ice /YY7yoo 111a 11fk Orrlitb, arrecldo„L GTrL 6c r i(K A- 102 515 3913 � !.® '4! .tw_.ua: r ^a - x..'Wt .1.r 5 a".. s". l'_" `�"c "*. •'' ,s'.ro!F._ ..:.1 ,T.�. ^'!E"b ' ice" -4��,iy,, C �+�'R�� � F � „�,� �.. �y,„.y-�y. �,�"-a U� ram„-.,,��ty� � x�. 5cA✓��ANY: w x.1- dm- 7�11" msa 5 �� ;,,.. ' �i 3 M1 Itz i 11 �,@ o "'7� 'A W r .r xi �j 'Sh n 5 �'I!-:i% "'el 'r-- .;:a y 3.. ti a xis. ' E 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. g. L. ,92..c9 r 1 Signature of Manager Applicant Signature of Spouse State of Nebraska County of 0 a(4. s S County of The foregoing.i strument Fas acknowledged before The foregoing instrument was acknowledged before me this_/ '/f by me this - by A ;/ Notary �1.blie signature Notary Public signature .Affix seal Lr `-n' "' ._ ' Affix Seal Here FAWNDA JOHNSON rio.;;:ki MY COMMISSION E)IPIRES t-----7-c- May 25,2012. In compliance with the ADA,this manager insert form 3c is available in other formats for persona with disabilities. A ten day advance period is required in writing to produce the alternate format. Revisal 5/2007 k Orrlitb, arrecldo„L GTrL 6c r i(K A- 102 515 3913 • O�,,HA' ,,,F City o Omaha, Nebray a V.�'�_ .,7 airtheik. 1819 Farnam —Suite LC 1 . It ,111 �,.� N Omaha, Nebraska 68183-0112 0 vw ;:�_,.., Buster Brown (402) 444-5550 �.6 ti' City Clerk FAX (402) 444-5263 O4' BR`}Q►4- FE October 15, 2008 American Legion Post#30 Application to appoint Willie Blake Dba"American Legion C Williamson 30" manager of your present Class "C" 1817 North 33`d Street Liquor License Omaha,NE 68111 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 October 28, 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, ,e‘ Buster Brown City Clerk BJB:clj usal 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. g. L. ,92..c9 r 1 Signature of Manager Applicant Signature of Spouse State of Nebraska County of 0 a(4. s S County of The foregoing.i strument Fas acknowledged before The foregoing instrument was acknowledged before me this_/ '/f by me this - by A ;/ Notary �1.blie signature Notary Public signature .Affix seal Lr `-n' "' ._ ' Affix Seal Here FAWNDA JOHNSON rio.;;:ki MY COMMISSION E)IPIRES t-----7-c- May 25,2012. In compliance with the ADA,this manager insert form 3c is available in other formats for persona with disabilities. A ten day advance period is required in writing to produce the alternate format. Revisal 5/2007 k Orrlitb, arrecldo„L GTrL 6c r i(K A- 102 515 3913 City ofOmaha, [Arebras&a :� I' °tp tier 1819 Farnam—Suite LC 1 2 r� �: Omaha, Nebraska 68183-0112 0 _� ;:. Buster Brown (402) 444-5550 �A (V City Clerk FAX.(402) 444-5263 O'P41 D FEBRvl+I. October 15, 2008 Willie Blake Application to be appointed manager of the present 6017 North 109th Street Class "C" Liquor Licenses for American Legion Post Omaha, NE 68164 30, dba"American Legion C Williamson 30", 1817 . North 33`d 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 October 28, 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 Commission. Sincerely yours, ,e‘ Buster Brown City Clerk BJB:clj usal 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. g. L. ,92..c9 r 1 Signature of Manager Applicant Signature of Spouse State of Nebraska County of 0 a(4. s S County of The foregoing.i strument Fas acknowledged before The foregoing instrument was acknowledged before me this_/ '/f by me this - by A ;/ Notary �1.blie signature Notary Public signature .Affix seal Lr `-n' "' ._ ' Affix Seal Here FAWNDA JOHNSON rio.;;:ki MY COMMISSION E)IPIRES t-----7-c- May 25,2012. In compliance with the ADA,this manager insert form 3c is available in other formats for persona with disabilities. A ten day advance period is required in writing to produce the alternate format. Revisal 5/2007 k Orrlitb, arrecldo„L GTrL 6c r i(K A- 102 515 3913 b I ;lc*. I Nn tno ; -„• � 00 'Ci ° "\ r„. - -‘ \; w ° o w o CD Cn 00 Ca. 'CZC CD P 0" 0 w0. 3 CD a 1 L