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RES 2008-0607 - SDL for beer garden at McFly's Center Street Tavern June 12-21 2008 ( )APPLICATION FOR SPECIAL • DESIGNATED LICENSE RETAIL LICENSE HOLDERS • NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH PO BOX 95046 • LINCOLN,NE 68509-5046 PHONE:(402)471-2571 FAX:(402)471-2814 Website:www.lcc.ne.gov/ $EFO.RE SSUB i- f i TIN6 APP1YC TI 10Q, 0 < I OMMEMM T AMP Include approval from the City, Village or County Clerk where the event is to be held Include signed statement from the local law enforcement(sec question#8) A license fee $40 (payable to Nebraska Liquor Control Commission) for each day/event to be licensed (i.e. if you have two separate areas at one event they both need to be licensed) (unless licensed as a K Caterer no fees required) _ Application MUST be received at the Liquor Control Commission Office no later than 10 working days prior to event(excluding weekends, Federal and State observed holidays) x +� tii --1`y„ -...4 r r^' � �r�r t^t. '3".t--c-+ �� E ..Y.-t�e r "�'� 'COMPLETE AI L. SEOIO S ._.... ._.�' �`� 4 ' r i _,r.�._,_ �` _f:..., `' ��f 3 �� FF 1. Type of alcohol to be served and/or consumed Beer 18,Wine 1513istilled Spirits 2. Liquor license number and class (i.e. C-55441) • C K - VS-as-7 3. Licensee name (last, first, middle), Corporate name, Limited Liability Company (LLC) NAME: ADDRESS: L/f-0 .5 TY Doe-t /4 :4-1e e. ,A/ 6 joG 4. Location where event will be held; name, address, city, county, zip code ADDRESS: QJ-03 C /7 S7 COUNTY aue2`,f a. Is this location within the city/village limits? `,®YES❑ NO b. Is this location within the 150' of church, school, hospital or home aged/indigent or for veterans their wives? ❑ YESNO c. Is this location within 300' of any.university or college campus? 0 YESXNO 5. Date(s)and Time(s)of event(no more then six(6) consecutive days on one application) Date 4,2 065 Date 6--/3- 045' Date 06 /y-o8 Date 06•-/5-00' Dated" >6 c.761 Date 9 -/7-4' Hours From Hours From Hours From Hours From Hours From Hours From NrkoN 04:04,4,E To is C4r1 66:0c,4r.To is etco 4r, To/'o,) ,;, ko-,667To/.'W,h.-, 0dcx' r+ To/ov.Fi+x6-4,..4w, To/ov a. Alternate date: //A • b. Alternate location: (alternate date or location must be approved by local and law enforcement) 6. Indicate type of activity to be carried on during event ❑ Dance 0 Reception 0 Fund Raiser ,N 3eer Garden ❑ Sampling/Tasting ❑ Other 7. Description of area to be licensed ❑ Inside building, dimensions of area to be covered INFEET x Name of building (not square feet or acres) tZ Outdoor area dimensions of area to be covered INFEET f,j j0 ' x /4/a (not square feet or acres) If outdoor area, how will premises be enclosed fence,type of fence 6, ';,,�,c�;/��, /�cyc fv,n r , !tent 30x 4'o ❑ other, explain *If both inside and outdoor area to be licensed include simple sketch 8. Attach a signed statement from:local police chief or county sheriff,whichever is applicable,that local law enforcement has been informed:in advance of this event, and if they are aware of any reason the event should not occur4'• '': • 9. Indicate the steps that will be taken to prevent underage persons from obtaining alcohol beverages. Ex .iect.t,i y ec/ 4j/ _T. s" /1/o6ce/y v v«/cr 01/ C//© , / 4' /''��e hoar f. 10. Will premises to be covered by license comply with all Nebraska sanitation laws? EYES ❑ NO a. Are there separate toilets for both men and women? EYES 0 NO r • 11. Will there be any games of chance operating during the event? X YES ❑ NO If so, describe activity Z.;4„Fnz: PJ AZ40 (a�,/s kC'yG, • SP /rNS , NOTE: Only games of chance approved by the Depaitnient of Revenue, Charitable Gaming Division are permitted. All other forms of gambling are prohibited by State Law: There are no exceptions for Non Profit Organizations or any events raising funds for a charity. This is only an application for a Special Designated License under the Liquor Control Act and is not a gambling permit application. 12. Any other information or requests for exemptions: 4acya�s�"1',/5 -cc.- CA.4f-�sl races m.es�'e v,¢,'l /a:Oc I�rits. 13. Name and telephone number/cell phone number of immediate supervisor. This person will be at t the location of the event when it occurs, able to answer any questions from Commission and/or law enforcement before and during the event, and who will be responsible for ensuring that any applicable laws, ordinances, rules and regulations are adhered to. pe < Phone: Before (-god CE O g/13'3 During S im Print name vent Supervisor • v nt Supervisor Consent of Authorized Representative/Applicant 14. I declare that I am the authorized representative of the above named license applicant and that the statements made on this application are true to the best of my knowledge and belief. I also consent to an investigation of my background including all records of every kind including police records. I agree to waive any rights or causes of action against the Nebraska Liquor Control Commission, the Nebraska State Patrol or any other individual releasing said information to the Liquor Control Commission or the Nebraska State Patrol. I further declare that the license applied for will not be used by any other person, group, organization or corporation for profit or not for profit and that the event will be supervised by persons directly responsible t the holder of this Special Designated License. sign '�- here ! . Gv✓►�� Oh/0 7 Aut re iz n of tive/A licant Title ate p PP rn Print Name • The law requires that no special designated license provided for by this section shall be issued by the Commission without the approval of the local governing body. For the purposes of this section,the local governing body shall be the city or village within which the particular place for which the special designated license is requested is located, or if such place is not within the corporate limits of a city or village, then the local governing body shall be the county within which the place for which the special designated license is requested is located. Ab � .4, 0 � cs � 4 CD ,_, O O a., g c t o cD � ono\ & NQ� •<rri ONO pH O -• E O cz, O - � � '-s C A 0. ,rt \c -'.--. \ .1 •~ e,-y ~' p • OW n • O O P d N V I N � g n co R. . - aL, " CD CO O n• CD T r- - < O 0 - CD N .-. IQ IV BCD O O O 0 00 00 • • • • .V /APPLICATION FOR SPECIAL DESIGNATED LICENSE RETAIL LICENSE HOLDERS NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH PO BOX 95046 LINCOLN,NE 68509-5046 PHONE:(402)471-2571 FAX:(402)471-2814 Website:www.Icc.ne.gov/ B'EEO RMIWINSI PpLtCA.T 411 gi SAE L ttiaOfi ' C 16 "R` s Include approval from the City, Village or County Clerk where the event is to be held Include signed statement from the local law enforcement (see question#8) A license fee $40 (payable to Nebraska Liquor Control Commission) for each day/event to be licensed(i.e. if you have two separate areas at one event they both need to be licensed) (unless licensed as a K Caterer no fees required) Application MUST be received at the Liquor Control Commission Office no later than 10 working days prior to event (excluding weekends, Federal and State observed holidays) C014K TE AFL UE,500§ x ,.Er P x r t Lti�4 . -z�, d ,r �x .... , ..� .. .,....._..�.. -... .. ��._< . .... ...�__.,� .__..�..._. t ._x�:..__.�.<a.�<''.F,..,L_E.,-.b '?,.,,........�:�i .......,,.. ..<.�.ta:._. ...E�.�.,,...��o._��.. y_..�..bls ._��._.ay...�4__...... 1. Type of alcohol to be served and/or consumed K,Beer Wine Distilled Spirits 2. Liquor license number and class (i.e. C-55441) C fr — G/S0,5 / 3. Licensee name (last, first, middle), Corporate,name, Limited Liability Company (LLC) NAME: / J L 6vzde>-7Jr/,Sc?5 C ADDRESS: 110 s C `Py S% COUNTY ,(7a 4,74 5' investigation of my background including all records of every kind including police records. I agree to waive any rights or causes of action against the Nebraska Liquor Control Commission, the Nebraska State Patrol or any other individual releasing said information to the Liquor Control Commission or the Nebraska State Patrol. I further declare that the license applied for will not be used by any other person, group, organization or corporation for profit or not for profit and that the event will be supervised by persons directly responsible t the holder of this Special Designated License. sign '�- here ! . Gv✓►�� Oh/0 7 Aut re iz n of tive/A licant Title ate p PP rn Print Name • The law requires that no special designated license provided for by this section shall be issued by the Commission without the approval of the local governing body. For the purposes of this section,the local governing body shall be the city or village within which the particular place for which the special designated license is requested is located, or if such place is not within the corporate limits of a city or village, then the local governing body shall be the county within which the place for which the special designated license is requested is located. 4. Location where event will be held; name, address, city, county, zip code -7pis ADDRESS: $17- COUNTY Paced S a. Is this location within the city/village limits? 'AYES 0 NO b. Is this location within the 150' of church, school, hospital or home aged/indigent or for veterans their wives? ❑ YES7KNO c. Is this location within 300' of any:university or college campus? ❑ YESNO 5. Date(s) and Tunes)of event(no more then sic (f) consecutive days on one application) Date dc,/we78 Date c.//2/63, Date46/;v/o8 Date Or////Off Date Date Hours From Hours From Hours From Hours From Hours From Hours From OLDdmro/.674' ^ e'..M, To/'Z-VACe 6 4M Toeva4/41 GZct,44"'To/;oai,G, To To a. Alternate date: /1/4 b. Alternate location: (alternate date or location must be approved by local and law enforcement) 6. Indicate type of activity to be carried on du ing event O Dance ❑ Reception ❑ Fund Raiser Beer Garden ❑ Sampling/Tasting ❑ Other 7. Description of area to be licensed O Inside building, dimensions of area to be covered INFEET x Name of building (not square feet or acres) Outdoor area dimensions of area to be covered INFEET /57 / x (not square feet or acres) If outdoor area, how will premises be enclosed 15 fence, type of fence e , g tent ❑ other, explain *If both inside and outdoor area to be licensed include simple sketch 8. Attach a signed statement from local policechief or county sheriff;whichever is applicable, that local law enforcement has been informed in dvance of this:event,.and if they are aware of any reason the event should not occur 9. Indicate the steps that will be!! taken to prevent underage persons from obtaining alcohol beverages. o Fkie SC'G�vt✓:�`7, G�(.4- c'/ y.I/•.3, '& c4 d.tGtc�i^ d l 4-4 43,Pdl/ s' / cd //tr c'r 10. Will premises to be covered by license comply with all Nebraska sanitation laws? tr YES ❑ NO a. Are there separate toilets for both men and women? DYES 0 NO ! . Gv✓►�� Oh/0 7 Aut re iz n of tive/A licant Title ate p PP rn Print Name • The law requires that no special designated license provided for by this section shall be issued by the Commission without the approval of the local governing body. For the purposes of this section,the local governing body shall be the city or village within which the particular place for which the special designated license is requested is located, or if such place is not within the corporate limits of a city or village, then the local governing body shall be the county within which the place for which the special designated license is requested is located. • • 11. Will there be any games of chance operating during the event? AYES 0 NO If so, describe activity �iy`ceL,cc✓ 4" 40o°„g S'o/de ,015:4 , NOTE: Only games of chance approved by the Department of Revenue, Charitable Gaming Division are permitted. All other forms of gambling are prohibited by State Law: There are no exceptions for Non Profit Organizations or any events raising funds for a charity. This is only an application for a Special Designated License under the Liquor Control Act and is not a gambling permit application. 12. Any other information or requests for exemptions: R.0 ctvvcf-£n`" -Ar O t ?✓ pn,a51.c Ueti'�% /�.° /o.:M - Ov+ X,/ 01.3:„0-- 13. Name and telephone number/cell phone number of immediate supervisor. This person will be at t the location of the event when it occurs, able to answer any questions from Commission and/or law enforcement before and during the event, and who will be responsible for ensuring that any applicable laws, ordinances, rules and regulations are adhered to. J T e/ 1 - L-avy -e Phone: Before 6-fod 6:0--6/83 During Print name of t Supervisor Signatur o nt pervisor Consent of Authorized Representative/Applicant 14. I declare that I am the authorized representative of the above named license applicant and that the statements made on this application are true to the best of my knowledge and belief. I also consent to an investigation of my background including all records of every kind including police records. I agree to waive any rights or causes of action against.the Nebraska Liquor Control Commission, the Nebraska State Patrol or any other individual releasing said information to the Liquor Control Commission or the Nebraska State Patrol. I further declare that the license applied for will not be used by any other person, group, organization or corporation for profit or not for profit and that the event will be supervised by persons directly responsibl- to the holder of this Special Designated License. sign 'J here te a.64/ WO 7/0 g i'o- epfesentative/Applicant Title Date •,) e-c---;rat / Print Name The law requires that no special designated license provided for by this section shall be issued by the Commission without the approval of the local governing body. For the purposes of this section,the local governing body shall be the city or village within which the particular place for which the special designated license is requested is located, or if such place is not within the corporate limits of a city or village,then the local governing body shall be the county within which the place for which the special designated license is requested is located. located. • °� CrJ o CMy Cn O O CD rt, CD ....ssi \ . . R°y � awn 1 IVC ` • .N. 00 d CCD C].. n N cr -• CCDD A.1 • up C_7 ono N r.r c N CD O N C) CD o P o CD ,..t g O • N 01 (.D F g O O O am, CAD I� O O v, ., v7 N O O O 0 00 00 • • • • .V