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RES 2008-0813 - Appoint Kari Gofta manager of Pizza Hut • • T��i_ a``E`S Tq � RECEIVEDSTATE OF NEBRASKA d i/ '�5 ..�i;; Dave Heineman • 1� Y 28 � © NEBRASKA LIQUOR CONTROL COMMISSION 1G v "'"''%� Governor t U� 1 l Hobert B. Rupe l 4. i ' - Executive Director CITY C L l i tit 301 Centennial Mall South,5th Floor 0144114 �t�- P.O.Box 95046 t `V y any Lincoln, Nebraska 68509-5046 Phone(402)471-2571 Fax(402)471-2814 TRS USER 800 833-7352(TTY) web address:http://www.lcc.ne.gov/ May 23, 2008 OMAHA CITY CLERK 1819 FARNAM STREET LC-1 OMAHA NE 68183 Dear Clerk: • Enclosed is a copy of a manager application for Kari Gofta in connection with Peak Interests LLC dba Pizza Hut, located at 13838 R Plaza, Omaha NE. Please present this application for manager to your Council and send us the results of their action. Sincerely, NEBRASKA LIQUOR CONTROL COMMISSION Je ash Licensing Division jc encl. cc: file Rhonda R. Flower Bob Logsdon Pat Thomas Commissioner Chairman Commissoner An Equal Opportunity/Affirmative Action Employer Printed with soy ink on recycled paper cerely yours, Buster Brown City Clerk BJB:clj re of Spouse State of Nebraska County of itaii,c-aiy—, .--- County of ,,rd_ The foregoing instrument was acknowledged before The foregoing instrument was acknowledged before me this _Mick, LI— by me this /ha . e I- by _6fefe.- -9 _......„{...Zeiza.......a d'a,--zit___.....). Notary Publi tgnature Notary Public sig tore Affix Seal H,i GENERAL NOTARY-State of Nebraska Affix Seal Here PATRICIA .SHEFLAND GENERAL NOTARY-State of Nebraska M My Comm.Exp.Dec.2,2009 I PATRICIA J.SHEFLAND 1 . My Comm.Exp.Dec.Z 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 S/2007 11 x,r � A 4,1 e A'ttn 1� 1"r'I,, y"1- r °".' �.fL",,=, u r 'd 1 � a f id * �IYi .P. ' �, �. F� f k. ct,�.s -� i i • t � i4 v F fi e v,am%n.., .x i��.^ 'f,a. Wit ,o.�.,i�I *�.: _ � s � 4 a•�+ k � � rexir '+ �ui��' .d(,�^P�% Y IV .,. �. tS'k a. 'II.�;'1 �,.`v"1Lt.','nf" �F.£1;r':d'... i�ab.r,+hi ,., M^s �Id. 3tn..,"_ YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER FROM TO 2o0,5— 2007 EMI - ,: r e0 c Jeo-0 1111 02-4-f)3-y 113 1V11111200s. d--0 41 I l s.n i S. A rcK aor-c, `t01'73 4L/b y - MANAGER APPLICATION EwE1Q�� �C,,��,,JJ RECEIVED `INSERT-FORM 3c R 1�� NEBRASKA LIQUOR CONTROL COMMISSION CENTENNIAL301MALLSOUTIi PO BOX 95046MAi 21 2(48 MAY 12 2008 PO LINCOLN,NE 68509-5046 PHONE: AX 402)47i1-2814571 CONTROL NEBRASKA UOUD OR NEBRASKA LIQUOR Website:www,icc.ne.eov ROL GOMMiSS CONTROL COMMISSION Corporate manager,including their spouse,are required to adhere to the following requirements 1) Must be a citizen of the United States f J 2) Must be a Nebraska resident(Chapter 2—006) (/�j/�• 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 .773,, ViPt>1 Name of Corporation/LLC: 'peek y --1-0 r sf__L I C. D'M. ? 7_2-ct 4.71-• `,W x `airs, '` r '41 Premise License Number: 3561 q a, Premise Trade Name/DBA: e—PZ'Z.c \-\04 Premise Street Address: 1M 34- . D1gZq City: OrnrANNA., State: fifty Zip Code: (Si Premise Phone Number: 4-10Z - g- c- 7 t -1-1 • GIs ,',,;"4!, A: .,i. .r? , a a' r ' k5 i ek tk .'\i' '' '7— CO ' 'ORATE OFFICER SIGNATURE (Faxed signatures are acceptable) . lai irii 0800010497 his _Mick, LI— by me this /ha . e I- by _6fefe.- -9 _......„{...Zeiza.......a d'a,--zit___.....). Notary Publi tgnature Notary Public sig tore Affix Seal H,i GENERAL NOTARY-State of Nebraska Affix Seal Here PATRICIA .SHEFLAND GENERAL NOTARY-State of Nebraska M My Comm.Exp.Dec.2,2009 I PATRICIA J.SHEFLAND 1 . My Comm.Exp.Dec.Z 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 S/2007 11 x,r � A 4,1 e A'ttn 1� 1"r'I,, y"1- r °".' �.fL",,=, u r 'd 1 � a f id * �IYi .P. ' �, �. F� f k. ct,�.s -� i i • t � i4 v F fi e v,am%n.., .x i��.^ 'f,a. Wit ,o.�.,i�I *�.: _ � s � 4 a•�+ k � � rexir '+ �ui��' .d(,�^P�% Y IV .,. �. tS'k a. 'II.�;'1 �,.`v"1Lt.','nf" �F.£1;r':d'... i�ab.r,+hi ,., M^s �Id. 3tn..,"_ YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER FROM TO 2o0,5— 2007 EMI - ,: r e0 c Jeo-0 1111 02-4-f)3-y 113 1V11111200s. d--0 41 I l s.n i S. A rcK aor-c, `t01'73 4L/b y • Ma iage 5 n mitst be Ibt$4belov✓ ' PRIN ,CLF, Y. - E - - ' CS'. ' %'-it. Gender: ❑MALE XFEMALE MAY 21 2008 NEBRASKA LIQUOR Last Name: Go First Name: 19NTROL COMMISSIOF vII: A Home Address (include PO Box if applicable):302 %Z A . (-2c !u t 4,1 . -11 2_ City: - 2..11_e V U Q State: Ale Zip Code: 6'OO S' Home Phone Number:6107-) 53 42- 0515'4 _Business Phone Number:(yp2) 9rQ$ - 71 77 Social Security Number: _ ,, _ , Drivers License Number& State: , ._, NE Date Of Birth:_ Place Of Birth: amaJ`ckO s :ltt rm Rtt011Y$ o fia gr. }.,a :ire •+' YES NO .a� .� •�., t ark ' d'n it f• p ,�, _ c � F .` i {. .'"'. � l i ice.� '� i i�A 1 4 ' �-i 1 me I. :,R a 4". .n aa` ►- a.d�� •_ a!e ., . r".�. M.. .... Spouses Last Name: First Name: MI: Social Security Number: Drivers License Number& State: Date Of Birth: Place Of Birth: .1; f t 24,KAir Pb.' MU•4 L Y 4 RE SD SCE(SkNOR'7F E P YE r CITY&STATE YEAR CITY&STATE YEAR FROM TO FROM TO 11eU ur, )11,_ 0 zoit gore OyvroNv, tic_ lag ,gamy .--:. -- ;...•M - r Jam, •y YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER FROM TO ,2 nn ?noc- ?z z zo.. 404, , ` &ei.,1 Goc i bpi` Iwo poO -Too _ pa NP c- 7dh, Notary Publi tgnature Notary Public sig tore Affix Seal H,i GENERAL NOTARY-State of Nebraska Affix Seal Here PATRICIA .SHEFLAND GENERAL NOTARY-State of Nebraska M My Comm.Exp.Dec.2,2009 I PATRICIA J.SHEFLAND 1 . My Comm.Exp.Dec.Z 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 S/2007 11 x,r � A 4,1 e A'ttn 1� 1"r'I,, y"1- r °".' �.fL",,=, u r 'd 1 � a f id * �IYi .P. ' �, �. F� f k. ct,�.s -� i i • t � i4 v F fi e v,am%n.., .x i��.^ 'f,a. Wit ,o.�.,i�I *�.: _ � s � 4 a•�+ k � � rexir '+ �ui��' .d(,�^P�% Y IV .,. �. tS'k a. 'II.�;'1 �,.`v"1Lt.','nf" �F.£1;r':d'... i�ab.r,+hi ,., M^s �Id. 3tn..,"_ YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER FROM TO 2o0,5— 2007 EMI - ,: r e0 c Jeo-0 1111 02-4-f)3-y 113 1V11111200s. d--0 41 I l s.n i S. A rcK aor-c, `t01'73 4L/b y , • Ii4,7,"•w n .,; ei the qi. s bel • ' e 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, cured anti 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, 14YES ENO If yes, please explain below or attach a separate page. 9.1)6 Dec igdoo 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 ZINO 3. Do you,as a manager,have all the qualifications required to hold a Nebraska Liquor License? Nebraska Liquor Control Act(§53-131.01) EYES DNO 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 P(2 W r 5 T AJew ScC ROM TO FROM TO 11eU ur, )11,_ 0 zoit gore OyvroNv, tic_ lag ,gamy .--:. -- ;...•M - r Jam, •y YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER FROM TO ,2 nn ?noc- ?z z zo.. 404, , ` &ei.,1 Goc i bpi` Iwo poO -Too _ pa NP c- 7dh, Notary Publi tgnature Notary Public sig tore Affix Seal H,i GENERAL NOTARY-State of Nebraska Affix Seal Here PATRICIA .SHEFLAND GENERAL NOTARY-State of Nebraska M My Comm.Exp.Dec.2,2009 I PATRICIA J.SHEFLAND 1 . My Comm.Exp.Dec.Z 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 S/2007 11 x,r � A 4,1 e A'ttn 1� 1"r'I,, y"1- r °".' �.fL",,=, u r 'd 1 � a f id * �IYi .P. ' �, �. F� f k. ct,�.s -� i i • t � i4 v F fi e v,am%n.., .x i��.^ 'f,a. Wit ,o.�.,i�I *�.: _ � s � 4 a•�+ k � � rexir '+ �ui��' .d(,�^P�% Y IV .,. �. tS'k a. 'II.�;'1 �,.`v"1Lt.','nf" �F.£1;r':d'... i�ab.r,+hi ,., M^s �Id. 3tn..,"_ YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER FROM TO 2o0,5— 2007 EMI - ,: r e0 c Jeo-0 1111 02-4-f)3-y 113 1V11111200s. d--0 41 I l s.n i S. A rcK aor-c, `t01'73 4L/b y • 04, s_ d `� /Tiy l _'i b Katy i• i,� E�.E��I�� t _ + a'° > . 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. Signature of Manager A licant Signature of Spouse State of Nebraska County of 1 S County of The foregoing instrument was acknowledged before The foregoing instrument was acknowledged before me this I 1 D`�6 by me this by Y-)00-1; ft 074 —6k /..„ • /4....c Notary P bllc sig :ture Notary Public signature Am Owl I Affix Seal Here GENERAL NOTARY-State of Nebraska MICHELE L.POKLADNIK i` My Comm.Exp,Feb.20,2011 • 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 5/2007 e alternate format. Revised S/2007 11 x,r � A 4,1 e A'ttn 1� 1"r'I,, y"1- r °".' �.fL",,=, u r 'd 1 � a f id * �IYi .P. ' �, �. F� f k. ct,�.s -� i i • t � i4 v F fi e v,am%n.., .x i��.^ 'f,a. Wit ,o.�.,i�I *�.: _ � s � 4 a•�+ k � � rexir '+ �ui��' .d(,�^P�% Y IV .,. �. tS'k a. 'II.�;'1 �,.`v"1Lt.','nf" �F.£1;r':d'... i�ab.r,+hi ,., M^s �Id. 3tn..,"_ YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER FROM TO 2o0,5— 2007 EMI - ,: r e0 c Jeo-0 1111 02-4-f)3-y 113 1V11111200s. d--0 41 I l s.n i S. A rcK aor-c, `t01'73 4L/b y • II OM�HA' qy ,, City of [Arebras&aOmaha ;� F Nur trc., 1819 Farnam—Suite LC 1 2 ffti -t Omaha, Nebraska 68183-0112 0 Buster Brown (402) 444-5550 �A City Clerk FAX (402) 444-5263 O9TFU FEBR�P�4 June 3, 2008 Peak. Interests, LLC Application to appoint Kari Gofta Dba"Pizza Hut" manager of your present Class 13838 "R" Plaza "I" Liquor License Omaha, NE 68137 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 June 17, 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 incomplete, inaccurate,or fraudulent. Signature of Manager A licant Signature of Spouse State of Nebraska County of 1 S County of The foregoing instrument was acknowledged before The foregoing instrument was acknowledged before me this I 1 D`�6 by me this by Y-)00-1; ft 074 —6k /..„ • /4....c Notary P bllc sig :ture Notary Public signature Am Owl I Affix Seal Here GENERAL NOTARY-State of Nebraska MICHELE L.POKLADNIK i` My Comm.Exp,Feb.20,2011 • 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 5/2007 e alternate format. Revised S/2007 11 x,r � A 4,1 e A'ttn 1� 1"r'I,, y"1- r °".' �.fL",,=, u r 'd 1 � a f id * �IYi .P. ' �, �. F� f k. ct,�.s -� i i • t � i4 v F fi e v,am%n.., .x i��.^ 'f,a. Wit ,o.�.,i�I *�.: _ � s � 4 a•�+ k � � rexir '+ �ui��' .d(,�^P�% Y IV .,. �. tS'k a. 'II.�;'1 �,.`v"1Lt.','nf" �F.£1;r':d'... i�ab.r,+hi ,., M^s �Id. 3tn..,"_ YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER FROM TO 2o0,5— 2007 EMI - ,: r e0 c Jeo-0 1111 02-4-f)3-y 113 1V11111200s. d--0 41 I l s.n i S. A rcK aor-c, `t01'73 4L/b y NF �^ , City ofOmaha, Nebras a :� �1I 49'.=41f: ailreOf 1819 F — 2, f1���t�V 8 9 arnam Suite LC 1 �® ; tL Omaha, Nebraska 68183-0112 0 �,' Buster Brown (402) 444-5550 �A 1 `�' City Clerk FAX (402) 444-5263 oR'T�D FEBRv4I- June 3, 2008 Kari Gofta Application to be appointed manager of the present 302 ''A N Galvin Rd #2 Class "I" Liquor License for Peak Interests,LLC, Bellevue, NE 68005 dba"Pizza Hut", 13838 "R" Plaza 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 June 17, 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 incomplete, inaccurate,or fraudulent. Signature of Manager A licant Signature of Spouse State of Nebraska County of 1 S County of The foregoing instrument was acknowledged before The foregoing instrument was acknowledged before me this I 1 D`�6 by me this by Y-)00-1; ft 074 —6k /..„ • /4....c Notary P bllc sig :ture Notary Public signature Am Owl I Affix Seal Here GENERAL NOTARY-State of Nebraska MICHELE L.POKLADNIK i` My Comm.Exp,Feb.20,2011 • 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 5/2007 e alternate format. Revised S/2007 11 x,r � A 4,1 e A'ttn 1� 1"r'I,, y"1- r °".' �.fL",,=, u r 'd 1 � a f id * �IYi .P. ' �, �. F� f k. ct,�.s -� i i • t � i4 v F fi e v,am%n.., .x i��.^ 'f,a. Wit ,o.�.,i�I *�.: _ � s � 4 a•�+ k � � rexir '+ �ui��' .d(,�^P�% Y IV .,. �. tS'k a. 'II.�;'1 �,.`v"1Lt.','nf" �F.£1;r':d'... i�ab.r,+hi ,., M^s �Id. 3tn..,"_ YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER FROM TO 2o0,5— 2007 EMI - ,: r e0 c Jeo-0 1111 02-4-f)3-y 113 1V11111200s. d--0 41 I l s.n i S. A rcK aor-c, `t01'73 4L/b y q ' 7 - p k ) n § P J U R 5 / \ CL ƒ ) 9 q ? 3 UCro @ \ » m az f \ • 0 a) \' ''SC.).1%N Q J - n • _ \ ` CD p ; § �. p i \ 3' . 7 \ / n 5 m 2 ƒ ¢ �2 8 I r \ _ �' _, m