RES 2008-1678 - Appoint Mark Kramer manager of Elks BPO Omaha Lodge 39 s4,S"7,
O y
.R EC E l v E l STATE OF NEBRASKA
ja >% NEBRASKA LIQUOR CONTROL COMMISSION
'VD
w� �;„�,��� �;;,�% Dave Heineman
4� D' - a < Hobert B. Rupe
, ;� ..: Governor p ,y/' � Q�
y 0U U i'„4+ 03 Executive Director
t� i �a 301 Centennial Mall South,5th Floor
P.O.Box 95046
CITY C i ER r'C Lincoln,Nebraska 68509-5046
one(402)471-2571
OMAHA, NtunAiSt« Ph Fax(402)471-2814
TRS USER 800 833-7352(TTY)
web address:http://www.lcc.ne.gov/
November 21, 2008
OMAHA CITY CLERK •
1819 FARNAM STREET LC-1
OMAHA NE 68183
Re: ELKS BPO OMAHA LODGE 39
DBA: ELKS BPO OMAHA LODGE 39
License #C-01339
Dear Clerk: •
Enclosed is a copy of a manager application for MARK KRAMER in connection ELKS
BPO OMAHA LODGE located at 6410 S 96" ST Liquor License #C-01339
•
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
Kristina Radicia
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
INSERf- FORM 3c
•
0 V •
NEBRASKA LIQUOR CONTROL COMMISSION ?'.•1,
30 IL'ENTENNIAL MALL SOUTH
PO BOX 9504(i 2111ii.
LINCOLN,NE 68509-5046
(•• (-
PHONE:(402)471-2571 . ••••,
FAX:(402)471-2814
Wcbsite:www,Ict.:,ne.gov PIAMiSSKOU7'
7 )Nihii(Pt.4;
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 OVC
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: _/° C:) te.9/4/'/4/444 Lc) 3
rt*tilise ktrifounatuirtl; - ; • 7* ?. '''' .4
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Premise License Number: (7 / 3 3
.42
Premise Trade Name/DBA: e 0 0/.144 4-0,06 e, c7
Premise Street Address: 6 q/0 S 9
City: 0/1,10 Act State: 4//e- Zip Code: 6 '1)...
Premise Phone NumberC/10.4) 33 9 .3.-57S--7
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CORPORATE OFWER SIGNATURE
(Faxed signatures are acceptable)
0800018016
s-4• ,
Manage e— _ntAo ta. d%
„ : ,•• ,.., •:J. ,' : , 3 4., 4 ''44 '''' ',.6 ..: ":'1A! .i;4., '7' ,,,c, '..1.1, :?,,,4 ,l, ,
Gender: MALE 0 FEMALE
Last Name: (\/aiNerN First Name: Pl&f.7( MI: R
Home Address (include PO Box if applicable): /707/ CCesr Cis' 4
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City: emoi 1 fi State: 47e, Zip Code: ‘e- o Vb
Home Phone Number: 4/0)- `f 3 / 61'6/ Business Phone Number: e7/0), a--03 --. 0/(5'
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Social Security Number: . . , Drivers License Number&State: _
Date Of Birth: _ Place Of Birth: friaSit'A 6-3 /it....-
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Spouses Last Name: Xi-Om-to- First Name: ck;
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Social Security Number: Drivers License Number& State: 1 , , /lie
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Date Of Birth: , . Place Of Birth: 0 fila AO r /1 e,-
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IMMONEMPRI •1•40.1.••••10•MMIMMONIMMONIMINIIMONINNI 4...
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CITY&STATE YEAR CITY&STATE YEAR
FROM TO FROM TO
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MANA0ERWVAST4WW
YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER
FROM TO
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Manager and spouse must review and:answ.er;:the `ite'stion ' elow ,': :_._ '
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PLEASE PRINT CLEARI,;. �{,
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/I. 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,.
EYES ONO If yes,please explain below or attach a separate page.
Deco 6-0)1 rY To 14 j9 u/ i ii. /99 (w ho, k
7a10'./7< i< t1.'t"^ j A key 'A r y 2 . cz c h-.q//y /c 9/ fleace
6 O'C ty /TO 4 te,'
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 fNO
\t Do you, as a manager,have all the qualifications required to hold a Nebraska Liquor License? Nebraska
Liquor Control Act(§53-131.01)
EYES ONO
Owire'' 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)
itYES ONO Q E ), re.
.
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MANA0ERWVAST4WW
YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER
FROM TO
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•
' ; R(ERSO . ° '' H AND CONSENT OF INVES7'•YGAT x. `.
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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.
//ti_____ g_._._____,
Signature of Manager Applicant Signature of Spouse
State of Nebraska
County of Sarp\.1 County of S 1rpy
The fore oin instrument was acknowledged before The foregoing instrument was acknowledged before _
me this !aa y 48 /UOV, 0 'by me this 7' day eg 1tb1/ OS7 by
(MY i S'fi n4 ` Rorrl a CJ7YjS-flr)a R 2aord a
07,_,,0-6.- R T167da.. eizilotita R
Notary Public signature Notary Public signature
Affix Seal Here _ Affix Seal Here
GENERAL NOTARY-State of Nebraska
� _.._.... .
CHRISTINA R.ROORDA
My Comm Exp.Apr.27,2009 GENERnI.NOT./mh'StMe of Nebraska
CHRiS iPaA R.ROORDA
_ . . My Comm.Exp.Apr.27,2009
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
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MANA0ERWVAST4WW
YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER
FROM TO
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SPOUSAL AFFIDAVIT OF Office Use , � +; - .
NON PARTICIPATION INSERT .,� �x x r.... a,'1 " `' ',,
NEBRASKA LIQUOR CONTROL COMMISSION
301 CENTENNIAL MALL SOUTH !0.:' :� i
POBOX95046 r N, � ,M, :`.. -1. :11,1w1
1.
LINCOLN,NE 68509.5046
PHONE:(402)471-2571 'ti Ls l 'S'1 4
FAX (402)471-2814 t_•at;;, ,r,,;• r,: 1 1"�,ctrt ; .t„f >
Website: vyww.Icc.ne.Lpv 'i"1!',r=;""�l`' "``. t t, ,'e
I a a.iov "ig- Os.t I'�"' the pot o a Q Icy o r. Iy n e o -^,h w�l t •N ,,
interest, irec• srlt ecttint opi itlo pr•.ito� :eh's in ( -1- (1 'o e euo- 'Cs. .i , i 1.,.
t ri' lbar, a : es ry.:41.r. st 1c shes, :to •tt c,• si iinv ce r ' es rn+.el ,.m. tt'oh'. ert fin ny
p, cipa ,'nth.. a k .,day s pe' ions 'thi ust t s '� •n • pa ty: . s @. f, p!n `l1
qui ;ho ver; mv• ig• . t. 4`.n 'dis ose y i arm on} i a mp , t tx -der . 0o s
iPl1ca,ion W`: ' .. . *. ' : ; e:. 4 .+ _
i--'---- VI-t Kfz-c- rne P--
Signature o spouse as ing for waiver Printed name of spouse asking for waiver
(Spouse of individual listed below)
State of AktYa S iC.C,
County of SO.rpv The foregoing instrument was acknowledged before me this
11J "7 / v8 by via). A. ,r�.mcy
ehii,06,,,,_.
date name of person acknowledged
T. 26IC _ "/„ Affix Seal
�((� GENERAL NOTARY-State of Nebraska
Notary Public signature CHRISTINA R.ROORDA
_,.,„_ My Comm.Exp.Apr.27,2009
4iac led "PhaV , P 'Spou ftlgabo fist idi" ual uri, . to th Taps y £ieu n.tt' ala seP si „f0
m ce w `,the ildrt.4's se ut as a ie.v t is4 err"•ed t rb. • in.6 l. tki o ''i.. i,, 3:?f'k (l t
, mI S10 eau, l ®',`s Voke e lien.r li ,tnse;HF,, ji'` k. - "Ip,:
/„✓• __________
7)10(-4 A Kisr..1F_',i`
Signature of individual involved with application Printed name of applying individual
(Spouse of individual listed above)
State of AJthva S k_4
County of p y The foregoing instrument was acknowledged before me this
i1h 1 C43 by I ► 1iYk Z KVaMGK
date name
a„,, name of person acknowledged
0�► r -�.,;, „ j/ Affix Seal
/LNotarU u U� Jam— R ARYStateofNebraska
Notary Public signature CHRISTINA R.ROORDA
w My Comm.Exp.Apr.27,2009
In compliance with the ADA,this spousal affidavit of non participation is available in other formats for persons with disabilities.
A ten day advance period is requested in writing to produce the alternate format.
FORM 35-4178
Revised 1/2008
O SHA, 4'F
u C No,it o Omaha Nebras a ;� e1 'Mireg �
"�'
1819 Farnam — Suite LC 1 2 ;f
Omaha, Nebraska 68183-0112 0® "Ilir:.•04,
Buster Brown (402) 444-5550o�A `\'
City Clerk FAX (402) 444-5263 N Z p FEBRv�►��
December 2, 2008
Elks B P 0 Omaha Lodge 39 Application to appoint Mark Kramer
6410 South 96th Street manager of your present Class "C"
Omaha,NE 68127 Liquor License
• 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 December 16,
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,
�-.�Jl��jr th'�.ft .S'e✓,,.'`i:��...fKSiUfZ'o'V`1.../'ems.. Li
Buster Brown
City Clerk
BJB:clj
of person acknowledged
T. 26IC _ "/„ Affix Seal
�((� GENERAL NOTARY-State of Nebraska
Notary Public signature CHRISTINA R.ROORDA
_,.,„_ My Comm.Exp.Apr.27,2009
4iac led "PhaV , P 'Spou ftlgabo fist idi" ual uri, . to th Taps y £ieu n.tt' ala seP si „f0
m ce w `,the ildrt.4's se ut as a ie.v t is4 err"•ed t rb. • in.6 l. tki o ''i.. i,, 3:?f'k (l t
, mI S10 eau, l ®',`s Voke e lien.r li ,tnse;HF,, ji'` k. - "Ip,:
/„✓• __________
7)10(-4 A Kisr..1F_',i`
Signature of individual involved with application Printed name of applying individual
(Spouse of individual listed above)
State of AJthva S k_4
County of p y The foregoing instrument was acknowledged before me this
i1h 1 C43 by I ► 1iYk Z KVaMGK
date name
a„,, name of person acknowledged
0�► r -�.,;, „ j/ Affix Seal
/LNotarU u U� Jam— R ARYStateofNebraska
Notary Public signature CHRISTINA R.ROORDA
w My Comm.Exp.Apr.27,2009
In compliance with the ADA,this spousal affidavit of non participation is available in other formats for persons with disabilities.
A ten day advance period is requested in writing to produce the alternate format.
FORM 35-4178
Revised 1/2008
OMAHA, Art
Cityo Omaha ebras a ��..� ..mow.
/ rnr,,
1819 Farnam—Suite LC 1 2 s" •
Omaha, Nebraska 68183-0112 0
Buster Brown (402) 444-5550 4.60 1 A
City Clerk FAX (402) 444-5263 R97'
Fp FE6R°s�
December 2, 2008
Mark Kramer Application to be appointed manager of the present
1114 Crest Circle Class "C"Liquor Licenses for Elks B P 0 Omaha Lodge
Lincoln,NE 68046 39, 6410 South 96`h 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 December
16, 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,
7-1
•
Buster Brown
City Clerk
BJB:clj
Sincerely yours,
�-.�Jl��jr th'�.ft .S'e✓,,.'`i:��...fKSiUfZ'o'V`1.../'ems.. Li
Buster Brown
City Clerk
BJB:clj
of person acknowledged
T. 26IC _ "/„ Affix Seal
�((� GENERAL NOTARY-State of Nebraska
Notary Public signature CHRISTINA R.ROORDA
_,.,„_ My Comm.Exp.Apr.27,2009
4iac led "PhaV , P 'Spou ftlgabo fist idi" ual uri, . to th Taps y £ieu n.tt' ala seP si „f0
m ce w `,the ildrt.4's se ut as a ie.v t is4 err"•ed t rb. • in.6 l. tki o ''i.. i,, 3:?f'k (l t
, mI S10 eau, l ®',`s Voke e lien.r li ,tnse;HF,, ji'` k. - "Ip,:
/„✓• __________
7)10(-4 A Kisr..1F_',i`
Signature of individual involved with application Printed name of applying individual
(Spouse of individual listed above)
State of AJthva S k_4
County of p y The foregoing instrument was acknowledged before me this
i1h 1 C43 by I ► 1iYk Z KVaMGK
date name
a„,, name of person acknowledged
0�► r -�.,;, „ j/ Affix Seal
/LNotarU u U� Jam— R ARYStateofNebraska
Notary Public signature CHRISTINA R.ROORDA
w My Comm.Exp.Apr.27,2009
In compliance with the ADA,this spousal affidavit of non participation is available in other formats for persons with disabilities.
A ten day advance period is requested in writing to produce the alternate format.
FORM 35-4178
Revised 1/2008
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