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RES 2008-0041 - Appoint Jean Averelle manager of Elks BPO Omaha Lodge :.i w: • ' STATE OF NEBRASKA ,y; ., _. NA aM RECEIVED Ve. � �' NEBRASKA LIQUOR CONTROL COMMISSION ti,W;!�'��t��;°y� Dave Heineman �4�•'��1 y Governor 07 DEC _6 AM 8 5 Hobert B. Rupe 4t .• O r! Executive Director 301 Centennial Mall South,5th Floor • CITY 1LFRK P.O.Box95046 OMAHA. NEBRASKA 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/ December 5, 2007 OMAHA CITY CLERK 1819 FARNAM STREET LC-1 OMAHA NE 68183 Dear Clerk: Enclosed is a copy of a manager application for Jean Averell in connection with Elks BPO Omaha Lodge 39 dba Elks BPO Omaha Lodge 39, located at 6410 S 96th Street, Omaha NE. Please present this application for manager to your Council and send us the results of their action. Sincerely, NEBRASKA LIQUOR CONTROL COMMISSION eli`j°1 -) Jen n Cash 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 clj vities that will be operated on the new premises. Please complete and return the attached. Ordinance No. 37046, passed June 7, 2005, requires each applicant to submit a written statement describing all types of business or activities that will be operated on the premises in conjunction with the proposed license. Attached is the statement to be signed and returned (hand deliver, mail or fax) to the City Clerk's Office 7 days in advance of the public hearing. Sincerely yours, , Buster Brown City Clerk BJB:clj 12Esc- (State Law) DISTANCE OF PROPOSED LICENSE TO ANY CHURCH -V\f-1 SCHOOL U 1(_..--H6SPITALME FOR THE AGED,INDIGE OR VETERANS VI --€OLLEGE OR UNIVERSITY (Authorized Signature) (Date) must be approved by the Landlord and the Landlord before manufacturing is begun or permits are executed and will be reviewed for conformance with this criteria and overall design quality. Approval or disapproval of sign submittal based on aesthetics or design shall remain the sole right of the Landlord and/or the Landlord. 2. Approval of sign drawings for the Premises does not constitute approval of manufacturing and installation. Landlord's written approval of Tenant's proposed sign drawings is required. 3. Tenant shall submit drawings and specifications for all proposed sign work to Landlord and the Landlord before fabrication. Two (2) sets of detailed drawings and any other requirements pursuant to the Landlord shall be submitted to Landlord. The drawings shall clearly show location, size, layout, method of attachment, design, colors, proposed graphics, logos, and position of sign on the building elevation. Tenant should note that approval may take two or more weeks. 4. Landlord shall return one (1) set of the sign drawings to the.Tenant marked "Approved" "Approved as Noted," or "Disapproved". Drawings marked "Approved" or "Approved as Noted" and returned to Tenant shall need to obtain any applicable sign permit from the City of Omaha. The City of Omaha will not approve the sign permit without a drawing marked with Landlord's approval. Drawings that have been marked as "Disapproved" are to be redesigned and resubmitted to the Landlord for approval. The Landlord will retain one (1) set of drawings. 5. No signage shall be manufactured or installed until the Landlord with the "Approved or "Approved as Noted" has returned the drawings. 6. All permits for signs and their installation shall be obtained by the Tenant or Tenant's 11/19/2007 nts in accordance with the provisions of section (s) of the Fundamental Lease Provisions section of this Lease. Such payment 11/19/2007 illegal, invalid, or unenforceable, there be added as a part of this lease a clause or provision as similar in terms to such illegal, invalid or unenforceable clause or provision as may be possible and be legal, valid and enforceable. Section 32.24 RIGHT AND REMEDIES. The remedies of the Landlord shall be cumulative, and no one of them be construed as exclusive of the other or any remedy provided by law. The rights and remedies provided hereunder shall survive the termination of this Lease. Section 32.25 CORPORATE AUTHORITY Tenant represents and warrants that it has full 11/19/2007. . /IP/ .. . ..- , , •-•:,--- W-- . . ".', , , - e--.3, 3, _I-- ,3••,33:-.333v ---,. ,-; ....--f-3 I,,P• -i:.f:--.:,:..--:, ..r.,-- .'- . .-...„ . T.'.'''....f.....?' Attest NEBRASKA LIQUOR CONTROL COMMISSION t/rZ4 ji ,izo4L,t,‘___ It ilt114 Executive Director Chairman tI-iis , ',:-';-,'„ri.,'.7 XA,ti7SU„ffiiiolitFAVRTV-tatIKTIZIMINWA/aTilm, r RIVISsirrigiMP.rft ":5 ” s-,4A--.,Att.M141,*!,,-.. 2A-e • .'•5c,i, . .-47,_,. - ' :•-zi•-, •%, ;-,•;.;,vc•.: A''''.;7.4•4'47.,fr Y..i.v 4,a0067.4 vm orAtir.140-.-ty-.• vAv8v. ,,,', v,,,,,,, A-4-x,),-, .1.,4' . . , ",,ev ..,....,. 2,i,,,,:::,,,,...Avy.04::,,wkwy ,e,"44,Nkefa we.IviA,0,, *4=. ,.., ; •,-ft !:& 'Z'4-',k cf'4X, ;kli';'•• •4'g'-',''W5-...!f:'''',"..' : - 1W." . '',..;:r!.,,. "V..-4...,Ztat•:,!4'...e.••••Y: "....e,,,:s4-;/ •- •-. ' - ,:-_.•-•; . • „ Form 35-4100 Rev.1/04 MANAGER APPLICATION Office Use INSERT- FORM 3c • NEBRASKA LIQUOR CONTROL COMMISSION : f`. 301 CENTENNIAL MALL SOUTH C t'.,. ... s PO BOX 95046 �' LINCOLN,NE 68509-5046i.,. PHONE:(402)471-2571 ?�;� I FAX:(402)471-2814 i;.:_,_ , Website:www.icc.ne.gov Corporate manager,including their spouse,are required to adhere to the following requiremcnt:' j 1) Must be a citizen of the United States C'-../ C 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 1 6) Applicant may be required to take a training course . ,a'Y'K�j P �a, I4 'a'�q�'✓.'F.Sr R .�rl_.__ 9C3aB .:S' _4z "1 A +r 34FSu, r x e.N _ 'F I� €_+ .t J3 I� M ft� "1 .fir i .14 " O S S 0 a -7. x i s 1^:g MI i s d {r I�•13F I -Y.'a,-A:t , ji'Fx,.}TAT i N F,c 9 f llla ii ° ' - �,. 1.� E z... ,!'� ,.iµ'r:x. r- .. ,s'%"yrp, "r-�:-. �Y-'�i�, .. - Idtg ''. dN1 .+�k... IVE h�r:•.7!.'�i :ik-u,- .. �,a..,,, ...i... .. Name of Corporation/LLC: ELKS B P C LM fi-IM' zD G& 2 1,r• f, ° s, + :,,-.17d I-ra �u ? • � ;� � . NS � � :s ti� a -'- +tea» ��9.,. e ` � <�4l Ra i xe. }n 1 7 ` Ira ' w Ic a b� �1 x y rOrnF ? ' '''f rlAst� ds ' I "m t�.t � ,i .., 7 :,,,,,_ Premise License Number: ® 1339 Premise Trade Name/DBA: ELF B P C D In I-- 14 Le)1)6 a 7 Premise Street Address: 4,111 0 S. 94.44 r-Q---e./ City: Q 614 het State: fig Zip Code: e:87 7 Premise Phone Number: 1f L'a.— 3 3' 3 55 ''•i , "" r ' ^ '� �^ ,n::' `":� w S,,� A1' t . - 1 a y. "- - j,...0 V+ ,q, F to 1 , i} 4 t t :::,„„-..1. S A.' 's 9 N t u a i r (}}, : �Ser 1.W Ilt J'a of IJ �' 'alr' .n' 4'rufi..,.�"F V at,i;.,4 '� x ' £ =, w ,f, O. .v �. t E �; .,,,,,,f. .310 },: v>s 11; �.,t mr I "Lt, �a S,II�r E } 6:'''‹* x ih'� q a� -v -f 4 IJr 1t15 ; a n 1 a h �y' I,� 1 ; � x -... ...,'u' 6' .. -: A 3. x�w. ..'�' 't ag o ta..' °ka x. ..;` . 1(11/ 11 '' 9?"-sa CORPORATE OFFICER SIGNATURE (Faxed signatures are acceptable) 111111111111111111 0700020281 rawings and specifications for all proposed sign work to Landlord and the Landlord before fabrication. Two (2) sets of detailed drawings and any other requirements pursuant to the Landlord shall be submitted to Landlord. The drawings shall clearly show location, size, layout, method of attachment, design, colors, proposed graphics, logos, and position of sign on the building elevation. Tenant should note that approval may take two or more weeks. 4. Landlord shall return one (1) set of the sign drawings to the.Tenant marked "Approved" "Approved as Noted," or "Disapproved". Drawings marked "Approved" or "Approved as Noted" and returned to Tenant shall need to obtain any applicable sign permit from the City of Omaha. The City of Omaha will not approve the sign permit without a drawing marked with Landlord's approval. Drawings that have been marked as "Disapproved" are to be redesigned and resubmitted to the Landlord for approval. The Landlord will retain one (1) set of drawings. 5. No signage shall be manufactured or installed until the Landlord with the "Approved or "Approved as Noted" has returned the drawings. 6. All permits for signs and their installation shall be obtained by the Tenant or Tenant's 11/19/2007 nts in accordance with the provisions of section (s) of the Fundamental Lease Provisions section of this Lease. Such payment 11/19/2007 illegal, invalid, or unenforceable, there be added as a part of this lease a clause or provision as similar in terms to such illegal, invalid or unenforceable clause or provision as may be possible and be legal, valid and enforceable. Section 32.24 RIGHT AND REMEDIES. The remedies of the Landlord shall be cumulative, and no one of them be construed as exclusive of the other or any remedy provided by law. The rights and remedies provided hereunder shall survive the termination of this Lease. Section 32.25 CORPORATE AUTHORITY Tenant represents and warrants that it has full 11/19/2007. . /IP/ .. . ..- , , •-•:,--- W-- . . ".', , , - e--.3, 3, _I-- ,3••,33:-.333v ---,. ,-; ....--f-3 I,,P• -i:.f:--.:,:..--:, ..r.,-- .'- . .-...„ . T.'.'''....f.....?' Attest NEBRASKA LIQUOR CONTROL COMMISSION t/rZ4 ji ,izo4L,t,‘___ It ilt114 Executive Director Chairman tI-iis , ',:-';-,'„ri.,'.7 XA,ti7SU„ffiiiolitFAVRTV-tatIKTIZIMINWA/aTilm, r RIVISsirrigiMP.rft ":5 ” s-,4A--.,Att.M141,*!,,-.. 2A-e • .'•5c,i, . .-47,_,. - ' :•-zi•-, •%, ;-,•;.;,vc•.: A''''.;7.4•4'47.,fr Y..i.v 4,a0067.4 vm orAtir.140-.-ty-.• vAv8v. ,,,', v,,,,,,, A-4-x,),-, .1.,4' . . , ",,ev ..,....,. 2,i,,,,:::,,,,...Avy.04::,,wkwy ,e,"44,Nkefa we.IviA,0,, *4=. ,.., ; •,-ft !:& 'Z'4-',k cf'4X, ;kli';'•• •4'g'-',''W5-...!f:'''',"..' : - 1W." . '',..;:r!.,,. "V..-4...,Ztat•:,!4'...e.••••Y: "....e,,,:s4-;/ •- •-. ' - ,:-_.•-•; . • „ Form 35-4100 Rev.1/04 • • ,w-,„-3 .:1: 21+,ew f_ y -A?., f• - h,F,,,:. 't""'r" 6,. -.1 E'ER ,M,,,,'- naY Itsfit fora t� '"is e'c-.0 p yr e ovv�.0 P°E 9 E : +J� 11'.._:. P "i -. i if fI;w,l t`` w ` 31let4,1 1.t , 3, l 1 +-�_,s.u°gaimil!hilt vtiliT � �r i0 _ "t, .., r f I Gender: E MALE M FEMALE Last Name: V-e( -e- I First Name: �e.c 6 MI: Home Address (include PO Box if applicable): 1 le ()3 L 5 p(tic 10 I►ft I t r'G/'-2.. City: ()mall a , State: Ai E Zip Code: 6 8// , Home Phone Number: 1 e; Soa—C 7 si - Business Phone Number: if-0 ,2— 5 q-'1-3 567 Social Security Number:_; Drivers License Number& State: A)E Date Of Birth: Place Of Birth: PE- K/N 4-- L r / y �yo`ina •��,t?I, _- pI t o_°i q 1 p� r _.f 1 in EC -..iL,,, rk�1:_`='`r�r Ar.4_;.�L. s..,,i-1'4 i ?. .'-• M,,"- k„a+ t l;rak.s'1s' ,aP 3 Y�geg".to::' '- -GL2L' -d' . -. -:+.� 51 YES ❑NO �t +��. •- � ;W v w• if,,-- ,' a n:-71aa ;� 1.1 js .7. 4 W," .—,- i*a � Paa„d'S6y`� � G 3'L 11 •}J t`�r�{��••°..�^1 3 3��a,L• ..-4ue jS. �Y-i+]..i 4N ''.� J 3 IE: ":"'-:`.rtwJ . -`w � 2;.'._� �`x7.�::4'Fs� ,7..» .G�t? 1^4y,-c&'+ - ;3., .n±? �1 i?i� s '1�� .te e Spouses Last Name: R V-e r_QJ I First Name: •27 ( S MI: S Social Security Number: i Y Drivers License Number& State: i_ `J 41D Date Of Birth: ( Place Of Birth: S5 T Z.0 CL /5 ( Al 0 h .. �•,fI�.. � �i otitkeH•," :S - 4 f. fE F�af � . � -'.�.:: c. a,%, a.•.J�r r 4 h2 E� a. � � 4T y�� ' $a I{ � �! N wow," Ay :,?--0- ii,,t 0 f. a. � � w, „ - " rt , t - - ° ' .w '4-, �.` � ; ` r v: _ : � ,i n x. M & •r. . r} .— ---;..r .;.,'s . ;•. .'i,,: ,F.. i .. -c i -4-.. ��s ...,... - g ,-• • --fit CITY&STATE YEAR CITY&STATE YEAR FROM TO FROM TO 9rn. Aq / /1/ „le—by Pry.ct-DmQ.AR /v6 oloo4 Prese - ,S� �'/.a i- I-e sf M U 1987 . goo d �T 'C�t w1 e-s1 /no 19. $9 „.00 ig-Arv .1 '. ..t n r---!�a-tea •s - -T: r a'.ra $g-- . ,7 "'.a'- v�,,,,, , ,4,r, ..7 y _ —++, :'� .`.�"sr-s'-+:,r.�,.•W- -1'ti `A� i" •--[-F •srf-• k..r.+= 'z-,..-� ,.a,-,.'i:�rx`a� a7.�`- s r' .my, .r";---' .. YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER FROM TO (r n `[)' 1 19 99 Pres--4- U Al t c r Pq_C>`P c l �r� ,��a-t tom-Dairt,YL I --D `f$ 1: c14, 1 Q4 9 B oe.i vt� ted to Landlord. The drawings shall clearly show location, size, layout, method of attachment, design, colors, proposed graphics, logos, and position of sign on the building elevation. Tenant should note that approval may take two or more weeks. 4. Landlord shall return one (1) set of the sign drawings to the.Tenant marked "Approved" "Approved as Noted," or "Disapproved". Drawings marked "Approved" or "Approved as Noted" and returned to Tenant shall need to obtain any applicable sign permit from the City of Omaha. The City of Omaha will not approve the sign permit without a drawing marked with Landlord's approval. Drawings that have been marked as "Disapproved" are to be redesigned and resubmitted to the Landlord for approval. The Landlord will retain one (1) set of drawings. 5. No signage shall be manufactured or installed until the Landlord with the "Approved or "Approved as Noted" has returned the drawings. 6. All permits for signs and their installation shall be obtained by the Tenant or Tenant's 11/19/2007 nts in accordance with the provisions of section (s) of the Fundamental Lease Provisions section of this Lease. Such payment 11/19/2007 illegal, invalid, or unenforceable, there be added as a part of this lease a clause or provision as similar in terms to such illegal, invalid or unenforceable clause or provision as may be possible and be legal, valid and enforceable. Section 32.24 RIGHT AND REMEDIES. The remedies of the Landlord shall be cumulative, and no one of them be construed as exclusive of the other or any remedy provided by law. The rights and remedies provided hereunder shall survive the termination of this Lease. Section 32.25 CORPORATE AUTHORITY Tenant represents and warrants that it has full 11/19/2007. . /IP/ .. . ..- , , •-•:,--- W-- . . ".', , , - e--.3, 3, _I-- ,3••,33:-.333v ---,. ,-; ....--f-3 I,,P• -i:.f:--.:,:..--:, ..r.,-- .'- . .-...„ . T.'.'''....f.....?' Attest NEBRASKA LIQUOR CONTROL COMMISSION t/rZ4 ji ,izo4L,t,‘___ It ilt114 Executive Director Chairman tI-iis , ',:-';-,'„ri.,'.7 XA,ti7SU„ffiiiolitFAVRTV-tatIKTIZIMINWA/aTilm, r RIVISsirrigiMP.rft ":5 ” s-,4A--.,Att.M141,*!,,-.. 2A-e • .'•5c,i, . .-47,_,. - ' :•-zi•-, •%, ;-,•;.;,vc•.: A''''.;7.4•4'47.,fr Y..i.v 4,a0067.4 vm orAtir.140-.-ty-.• vAv8v. ,,,', v,,,,,,, A-4-x,),-, .1.,4' . . , ",,ev ..,....,. 2,i,,,,:::,,,,...Avy.04::,,wkwy ,e,"44,Nkefa we.IviA,0,, *4=. ,.., ; •,-ft !:& 'Z'4-',k cf'4X, ;kli';'•• •4'g'-',''W5-...!f:'''',"..' : - 1W." . '',..;:r!.,,. "V..-4...,Ztat•:,!4'...e.••••Y: "....e,,,:s4-;/ •- •-. ' - ,:-_.•-•; . • „ Form 35-4100 Rev.1/04 , • "A by h {g4u'yr$$' rY' r� `� i�L' ¢K'r' '� i +i" a",{� 1-..? 9K4.t' ""i .V d'CiK` f '" 11 7: �T;I A%3'C'. . '�: ,1 1 r 2` 'T ,E,: f. 1 :— �, In ,+�'k r �, at h ,rG'a � ram. '� A>; � �i d i d" �' 4 1 -f1:' I��t n?� ��EI is `-�.s. M d' hl It-if:- • ;Ik � Rt',3L-MS � y�l y' � f.�dl�'tii�b I.y a'I�� .!t" v. it "x_�� - ,. �. 4'�'�.� �R �.��'" ..�u �' d+� '� Ie � i� -��s ��a'„�lii .:�'" yy;; kr �` Ii�$ � 3 5.uY-° � upI ��' a* �r T+.,r,,i- }pd� i�1 11 tk'a. k`� .API. '! '� � k ^R y p n3Ji� �''� rai' r �J! .I�I�� hat V' ��4�I '1 �� , „4.,.,,, k,i-i- � .,�€ I U � r � �4a5 l�-'�� r�--�II�i^,, i'I #ilP .a', ,* "5 ° Ir r '. ,, �, �,�,5" a h� �,,'�i � ih,, i G4 - .. t $Fj li.a. "a. d _ f. '` u OM t','4t€;I. J _� iI t l 9r h• "� .. ,,, k . i a ��...,� 0; n4 yak ;l r n w 3{ e�x.'��dr'fl�i"i JI 41 a.-pa.. P� G�§ip'7'_d!�i i'i4' �.E,d;:- {� `WLF. �rPM'u:+1G�d!>k. "Xts rai��iE�N ,!r-S:kl.::"tG # Gc: 'r�'Gunvmdu lfi: - S.Vi�..YLa...: 'FF4dYutY'N "nl�s°Atk.. .r.,.:✓i+.0 4. w...a 633.d�IFS��:.a^` �c..; a1 ; f 1. READ PARAGRAPH CAREFULLY AND ANSWER COMPLETELY AND ACCITAT, LY. coNTisic): .;: ;c.t'.yP. 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 i 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 NNO 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 d JNO 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 ENO 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$38.00 per person) *OYES tax:.. �},4,,.,,. f• ,-1y '1 M r R91ytAi13M'11{3fi WA :I 1 L.=,,,1, Ga^ n111 A ord`..,.,i PR�I s ' 1.(/c i)IMN.�I13,t18!10�( ...�n. i 1 19 99 Pres--4- U Al t c r Pq_C>`P c l �r� ,��a-t tom-Dairt,YL I --D `f$ 1: c14, 1 Q4 9 B oe.i vt� ted to Landlord. The drawings shall clearly show location, size, layout, method of attachment, design, colors, proposed graphics, logos, and position of sign on the building elevation. Tenant should note that approval may take two or more weeks. 4. Landlord shall return one (1) set of the sign drawings to the.Tenant marked "Approved" "Approved as Noted," or "Disapproved". Drawings marked "Approved" or "Approved as Noted" and returned to Tenant shall need to obtain any applicable sign permit from the City of Omaha. The City of Omaha will not approve the sign permit without a drawing marked with Landlord's approval. Drawings that have been marked as "Disapproved" are to be redesigned and resubmitted to the Landlord for approval. The Landlord will retain one (1) set of drawings. 5. No signage shall be manufactured or installed until the Landlord with the "Approved or "Approved as Noted" has returned the drawings. 6. All permits for signs and their installation shall be obtained by the Tenant or Tenant's 11/19/2007 nts in accordance with the provisions of section (s) of the Fundamental Lease Provisions section of this Lease. Such payment 11/19/2007 illegal, invalid, or unenforceable, there be added as a part of this lease a clause or provision as similar in terms to such illegal, invalid or unenforceable clause or provision as may be possible and be legal, valid and enforceable. Section 32.24 RIGHT AND REMEDIES. The remedies of the Landlord shall be cumulative, and no one of them be construed as exclusive of the other or any remedy provided by law. The rights and remedies provided hereunder shall survive the termination of this Lease. Section 32.25 CORPORATE AUTHORITY Tenant represents and warrants that it has full 11/19/2007. . /IP/ .. . ..- , , •-•:,--- W-- . . ".', , , - e--.3, 3, _I-- ,3••,33:-.333v ---,. ,-; ....--f-3 I,,P• -i:.f:--.:,:..--:, ..r.,-- .'- . .-...„ . T.'.'''....f.....?' Attest NEBRASKA LIQUOR CONTROL COMMISSION t/rZ4 ji ,izo4L,t,‘___ It ilt114 Executive Director Chairman tI-iis , ',:-';-,'„ri.,'.7 XA,ti7SU„ffiiiolitFAVRTV-tatIKTIZIMINWA/aTilm, r RIVISsirrigiMP.rft ":5 ” s-,4A--.,Att.M141,*!,,-.. 2A-e • .'•5c,i, . .-47,_,. - ' :•-zi•-, •%, ;-,•;.;,vc•.: A''''.;7.4•4'47.,fr Y..i.v 4,a0067.4 vm orAtir.140-.-ty-.• vAv8v. ,,,', v,,,,,,, A-4-x,),-, .1.,4' . . , ",,ev ..,....,. 2,i,,,,:::,,,,...Avy.04::,,wkwy ,e,"44,Nkefa we.IviA,0,, *4=. ,.., ; •,-ft !:& 'Z'4-',k cf'4X, ;kli';'•• •4'g'-',''W5-...!f:'''',"..' : - 1W." . '',..;:r!.,,. "V..-4...,Ztat•:,!4'...e.••••Y: "....e,,,:s4-;/ •- •-. ' - ,:-_.•-•; . • „ Form 35-4100 Rev.1/04 • y k o4 ` rk r. , IL ,, fk 1 ,' : j k r 7 r'!9�,�+r"M e» :: a 5 W = kF" t G • .. I� r.rlr+A_ 'y.'M._�-: - tin N6'�d'' :ti. '-�'" It, : _ .. ti AllA 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. • z z, <( • Signature of Manager Applicant Signature of Spouse State of Nebraska County of `. County of \ '�f The foregoing instrument was acknowledged before The foregoing instrument was acknowledged before me this /t" d�t. � ( •ekry�',ltz` i by .S-k• !�v.t t Ame this /tJic�: �,� L�(Y,;.f/ r zir 11 by KiYj� ft eli St. • Notary Public signature Notar ublic signature . I Affix Seal Here Affix Seal Here XelflitlNOURY•ilis ti .4:4ERAL NOTARY. frtNebraska My Call.6m.11m 11.2011 AmY MyC ROMMQFMdG ER 1,2011 • 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 PROPER FEES with this application? (The check or money order must be made out to the Nebraska State Patrol for$38.00 per person) *OYES tax:.. �},4,,.,,. f• ,-1y '1 M r R91ytAi13M'11{3fi WA :I 1 L.=,,,1, Ga^ n111 A ord`..,.,i PR�I s ' 1.(/c i)IMN.�I13,t18!10�( ...�n. i 1 19 99 Pres--4- U Al t c r Pq_C>`P c l �r� ,��a-t tom-Dairt,YL I --D `f$ 1: c14, 1 Q4 9 B oe.i vt� ted to Landlord. The drawings shall clearly show location, size, layout, method of attachment, design, colors, proposed graphics, logos, and position of sign on the building elevation. Tenant should note that approval may take two or more weeks. 4. Landlord shall return one (1) set of the sign drawings to the.Tenant marked "Approved" "Approved as Noted," or "Disapproved". Drawings marked "Approved" or "Approved as Noted" and returned to Tenant shall need to obtain any applicable sign permit from the City of Omaha. The City of Omaha will not approve the sign permit without a drawing marked with Landlord's approval. Drawings that have been marked as "Disapproved" are to be redesigned and resubmitted to the Landlord for approval. The Landlord will retain one (1) set of drawings. 5. No signage shall be manufactured or installed until the Landlord with the "Approved or "Approved as Noted" has returned the drawings. 6. All permits for signs and their installation shall be obtained by the Tenant or Tenant's 11/19/2007 nts in accordance with the provisions of section (s) of the Fundamental Lease Provisions section of this Lease. Such payment 11/19/2007 illegal, invalid, or unenforceable, there be added as a part of this lease a clause or provision as similar in terms to such illegal, invalid or unenforceable clause or provision as may be possible and be legal, valid and enforceable. Section 32.24 RIGHT AND REMEDIES. The remedies of the Landlord shall be cumulative, and no one of them be construed as exclusive of the other or any remedy provided by law. The rights and remedies provided hereunder shall survive the termination of this Lease. Section 32.25 CORPORATE AUTHORITY Tenant represents and warrants that it has full 11/19/2007. . /IP/ .. . ..- , , •-•:,--- W-- . . ".', , , - e--.3, 3, _I-- ,3••,33:-.333v ---,. ,-; ....--f-3 I,,P• -i:.f:--.:,:..--:, ..r.,-- .'- . .-...„ . T.'.'''....f.....?' Attest NEBRASKA LIQUOR CONTROL COMMISSION t/rZ4 ji ,izo4L,t,‘___ It ilt114 Executive Director Chairman tI-iis , ',:-';-,'„ri.,'.7 XA,ti7SU„ffiiiolitFAVRTV-tatIKTIZIMINWA/aTilm, r RIVISsirrigiMP.rft ":5 ” s-,4A--.,Att.M141,*!,,-.. 2A-e • .'•5c,i, . .-47,_,. - ' :•-zi•-, •%, ;-,•;.;,vc•.: A''''.;7.4•4'47.,fr Y..i.v 4,a0067.4 vm orAtir.140-.-ty-.• vAv8v. ,,,', v,,,,,,, A-4-x,),-, .1.,4' . . , ",,ev ..,....,. 2,i,,,,:::,,,,...Avy.04::,,wkwy ,e,"44,Nkefa we.IviA,0,, *4=. ,.., ; •,-ft !:& 'Z'4-',k cf'4X, ;kli';'•• •4'g'-',''W5-...!f:'''',"..' : - 1W." . '',..;:r!.,,. "V..-4...,Ztat•:,!4'...e.••••Y: "....e,,,:s4-;/ •- •-. ' - ,:-_.•-•; . • „ Form 35-4100 Rev.1/04 • NEBRASKA LIQUOR CONTROL COMMISSION ?It; AFFIDAVIT OF NON PARTICIPATION r)' The undersigned individual acknowledges that he/she will have no interest, directly or indirectly, in the operation or profit of the business, as prescribed in Section §53-125(13) of the Liquor Control.Act. Such individual shall not tend bar, make sales, serve patrons, • stock shelves, write checks, sign invoices, represent themselves as owner or in any way participate in the day to day operations in any capacity. The undersigned individual will also be waived of filing fingerprint cards, however, will be required to disclose any violation(s) on all applications and sign all necessary documents. • Signature of Spouse Asking to be. aived SUBSCRIBED in my presence and sworn to before me this 1 day of )2CeMl2:T , G20c2-7 • . Gum.NOTARY-State of Nebraska DAVID BENSON Signature of Notary Public 009 'tom My Comm.Exp.May 5.2 g rY The applying individual, whose spouse is requesting to be waived, understands that he/she is responsible for compliance with the conditions set out above, and that if such terms are violated,the Commission may cancel or revoke the license. , � c?ct s� 7 i!-e [ *Signature of applying individual Print name of applying individual (spouse of individual listed above) Si- SUBSCRIBED in my presence and sworn to before me this / day • of be e.4e-i- . , ,2oo7 GINERAL NOTARY-State of Nebraska pl DAVID BENSON Signature of NotaryPublic 171 My Comm.Exp.May 5.2009 • g *spouse of individual listed above is the individual required to sign bottom portion of affidavit FORM 35-4178 • REV 9/05 r 11 by KiYj� ft eli St. • Notary Public signature Notar ublic signature . I Affix Seal Here Affix Seal Here XelflitlNOURY•ilis ti .4:4ERAL NOTARY. frtNebraska My Call.6m.11m 11.2011 AmY MyC ROMMQFMdG ER 1,2011 • 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 PROPER FEES with this application? (The check or money order must be made out to the Nebraska State Patrol for$38.00 per person) *OYES tax:.. �},4,,.,,. f• ,-1y '1 M r R91ytAi13M'11{3fi WA :I 1 L.=,,,1, Ga^ n111 A ord`..,.,i PR�I s ' 1.(/c i)IMN.�I13,t18!10�( ...�n. i 1 19 99 Pres--4- U Al t c r Pq_C>`P c l �r� ,��a-t tom-Dairt,YL I --D `f$ 1: c14, 1 Q4 9 B oe.i vt� ted to Landlord. The drawings shall clearly show location, size, layout, method of attachment, design, colors, proposed graphics, logos, and position of sign on the building elevation. Tenant should note that approval may take two or more weeks. 4. Landlord shall return one (1) set of the sign drawings to the.Tenant marked "Approved" "Approved as Noted," or "Disapproved". Drawings marked "Approved" or "Approved as Noted" and returned to Tenant shall need to obtain any applicable sign permit from the City of Omaha. The City of Omaha will not approve the sign permit without a drawing marked with Landlord's approval. Drawings that have been marked as "Disapproved" are to be redesigned and resubmitted to the Landlord for approval. The Landlord will retain one (1) set of drawings. 5. No signage shall be manufactured or installed until the Landlord with the "Approved or "Approved as Noted" has returned the drawings. 6. All permits for signs and their installation shall be obtained by the Tenant or Tenant's 11/19/2007 nts in accordance with the provisions of section (s) of the Fundamental Lease Provisions section of this Lease. Such payment 11/19/2007 illegal, invalid, or unenforceable, there be added as a part of this lease a clause or provision as similar in terms to such illegal, invalid or unenforceable clause or provision as may be possible and be legal, valid and enforceable. Section 32.24 RIGHT AND REMEDIES. The remedies of the Landlord shall be cumulative, and no one of them be construed as exclusive of the other or any remedy provided by law. The rights and remedies provided hereunder shall survive the termination of this Lease. Section 32.25 CORPORATE AUTHORITY Tenant represents and warrants that it has full 11/19/2007. . /IP/ .. . ..- , , •-•:,--- W-- . . ".', , , - e--.3, 3, _I-- ,3••,33:-.333v ---,. ,-; ....--f-3 I,,P• -i:.f:--.:,:..--:, ..r.,-- .'- . .-...„ . T.'.'''....f.....?' Attest NEBRASKA LIQUOR CONTROL COMMISSION t/rZ4 ji ,izo4L,t,‘___ It ilt114 Executive Director Chairman tI-iis , ',:-';-,'„ri.,'.7 XA,ti7SU„ffiiiolitFAVRTV-tatIKTIZIMINWA/aTilm, r RIVISsirrigiMP.rft ":5 ” s-,4A--.,Att.M141,*!,,-.. 2A-e • .'•5c,i, . .-47,_,. - ' :•-zi•-, •%, ;-,•;.;,vc•.: A''''.;7.4•4'47.,fr Y..i.v 4,a0067.4 vm orAtir.140-.-ty-.• vAv8v. ,,,', v,,,,,,, A-4-x,),-, .1.,4' . . , ",,ev ..,....,. 2,i,,,,:::,,,,...Avy.04::,,wkwy ,e,"44,Nkefa we.IviA,0,, *4=. ,.., ; •,-ft !:& 'Z'4-',k cf'4X, ;kli';'•• •4'g'-',''W5-...!f:'''',"..' : - 1W." . '',..;:r!.,,. "V..-4...,Ztat•:,!4'...e.••••Y: "....e,,,:s4-;/ •- •-. ' - ,:-_.•-•; . • „ Form 35-4100 Rev.1/04 • OF OrA A 1„A, NF4� CityofOmaha, fAlebraskg . 1819 Farnam—Suite LC 1 z = Omaha, Nebraska 68183-0112 0� �' Buster Brown (402) 444-5550 0 City Clerk FAX (402) 444-5263 4) ��.�` 47'to FEgR 'December 21, 2007 Elks BPO Omaha Lodge 39 Application to appoint Jean Averell 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 January 8, 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, / . c-4 Buster Brown City Clerk BJB:clj (spouse of individual listed above) Si- SUBSCRIBED in my presence and sworn to before me this / day • of be e.4e-i- . , ,2oo7 GINERAL NOTARY-State of Nebraska pl DAVID BENSON Signature of NotaryPublic 171 My Comm.Exp.May 5.2009 • g *spouse of individual listed above is the individual required to sign bottom portion of affidavit FORM 35-4178 • REV 9/05 r 11 by KiYj� ft eli St. • Notary Public signature Notar ublic signature . I Affix Seal Here Affix Seal Here XelflitlNOURY•ilis ti .4:4ERAL NOTARY. frtNebraska My Call.6m.11m 11.2011 AmY MyC ROMMQFMdG ER 1,2011 • 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 PROPER FEES with this application? (The check or money order must be made out to the Nebraska State Patrol for$38.00 per person) *OYES tax:.. �},4,,.,,. f• ,-1y '1 M r R91ytAi13M'11{3fi WA :I 1 L.=,,,1, Ga^ n111 A ord`..,.,i PR�I s ' 1.(/c i)IMN.�I13,t18!10�( ...�n. i 1 19 99 Pres--4- U Al t c r Pq_C>`P c l �r� ,��a-t tom-Dairt,YL I --D `f$ 1: c14, 1 Q4 9 B oe.i vt� ted to Landlord. The drawings shall clearly show location, size, layout, method of attachment, design, colors, proposed graphics, logos, and position of sign on the building elevation. Tenant should note that approval may take two or more weeks. 4. Landlord shall return one (1) set of the sign drawings to the.Tenant marked "Approved" "Approved as Noted," or "Disapproved". Drawings marked "Approved" or "Approved as Noted" and returned to Tenant shall need to obtain any applicable sign permit from the City of Omaha. The City of Omaha will not approve the sign permit without a drawing marked with Landlord's approval. Drawings that have been marked as "Disapproved" are to be redesigned and resubmitted to the Landlord for approval. The Landlord will retain one (1) set of drawings. 5. No signage shall be manufactured or installed until the Landlord with the "Approved or "Approved as Noted" has returned the drawings. 6. All permits for signs and their installation shall be obtained by the Tenant or Tenant's 11/19/2007 nts in accordance with the provisions of section (s) of the Fundamental Lease Provisions section of this Lease. Such payment 11/19/2007 illegal, invalid, or unenforceable, there be added as a part of this lease a clause or provision as similar in terms to such illegal, invalid or unenforceable clause or provision as may be possible and be legal, valid and enforceable. Section 32.24 RIGHT AND REMEDIES. The remedies of the Landlord shall be cumulative, and no one of them be construed as exclusive of the other or any remedy provided by law. The rights and remedies provided hereunder shall survive the termination of this Lease. Section 32.25 CORPORATE AUTHORITY Tenant represents and warrants that it has full 11/19/2007. . /IP/ .. . ..- , , •-•:,--- W-- . . ".', , , - e--.3, 3, _I-- ,3••,33:-.333v ---,. ,-; ....--f-3 I,,P• -i:.f:--.:,:..--:, ..r.,-- .'- . .-...„ . T.'.'''....f.....?' Attest NEBRASKA LIQUOR CONTROL COMMISSION t/rZ4 ji ,izo4L,t,‘___ It ilt114 Executive Director Chairman tI-iis , ',:-';-,'„ri.,'.7 XA,ti7SU„ffiiiolitFAVRTV-tatIKTIZIMINWA/aTilm, r RIVISsirrigiMP.rft ":5 ” s-,4A--.,Att.M141,*!,,-.. 2A-e • .'•5c,i, . .-47,_,. - ' :•-zi•-, •%, ;-,•;.;,vc•.: A''''.;7.4•4'47.,fr Y..i.v 4,a0067.4 vm orAtir.140-.-ty-.• vAv8v. ,,,', v,,,,,,, A-4-x,),-, .1.,4' . . , ",,ev ..,....,. 2,i,,,,:::,,,,...Avy.04::,,wkwy ,e,"44,Nkefa we.IviA,0,, *4=. ,.., ; •,-ft !:& 'Z'4-',k cf'4X, ;kli';'•• •4'g'-',''W5-...!f:'''',"..' : - 1W." . '',..;:r!.,,. "V..-4...,Ztat•:,!4'...e.••••Y: "....e,,,:s4-;/ •- •-. ' - ,:-_.•-•; . • „ Form 35-4100 Rev.1/04 • otiAAHA, N City ofOmaha fAleôras&a of ,, �8.� .�`�1/I °d� 1819 Farnam —Suite LC 1 -, riIA( '•d Omaha, Nebraska 68183-0112 o -"r _;: �' Buster Brown (402) 444-5550 A ell' City Clerk FAX (402) 444-5263 04, 4� TFo FEgR3� December 21, 2007 Jean Averell Application to be appointed manager of the present 16036 Spaulding Circle Class "C" Liquor License for Elks BPO Lodge 39, Omaha,NE 68116 6410 South 96th 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 January 8t 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 L l listed above) Si- SUBSCRIBED in my presence and sworn to before me this / day • of be e.4e-i- . , ,2oo7 GINERAL NOTARY-State of Nebraska pl DAVID BENSON Signature of NotaryPublic 171 My Comm.Exp.May 5.2009 • g *spouse of individual listed above is the individual required to sign bottom portion of affidavit FORM 35-4178 • REV 9/05 r 11 by KiYj� ft eli St. • Notary Public signature Notar ublic signature . I Affix Seal Here Affix Seal Here XelflitlNOURY•ilis ti .4:4ERAL NOTARY. frtNebraska My Call.6m.11m 11.2011 AmY MyC ROMMQFMdG ER 1,2011 • 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 PROPER FEES with this application? (The check or money order must be made out to the Nebraska State Patrol for$38.00 per person) *OYES tax:.. �},4,,.,,. f• ,-1y '1 M r R91ytAi13M'11{3fi WA :I 1 L.=,,,1, Ga^ n111 A ord`..,.,i PR�I s ' 1.(/c i)IMN.�I13,t18!10�( ...�n. i 1 19 99 Pres--4- U Al t c r Pq_C>`P c l �r� ,��a-t tom-Dairt,YL I --D `f$ 1: c14, 1 Q4 9 B oe.i vt� ted to Landlord. The drawings shall clearly show location, size, layout, method of attachment, design, colors, proposed graphics, logos, and position of sign on the building elevation. Tenant should note that approval may take two or more weeks. 4. Landlord shall return one (1) set of the sign drawings to the.Tenant marked "Approved" "Approved as Noted," or "Disapproved". Drawings marked "Approved" or "Approved as Noted" and returned to Tenant shall need to obtain any applicable sign permit from the City of Omaha. The City of Omaha will not approve the sign permit without a drawing marked with Landlord's approval. Drawings that have been marked as "Disapproved" are to be redesigned and resubmitted to the Landlord for approval. The Landlord will retain one (1) set of drawings. 5. No signage shall be manufactured or installed until the Landlord with the "Approved or "Approved as Noted" has returned the drawings. 6. All permits for signs and their installation shall be obtained by the Tenant or Tenant's 11/19/2007 nts in accordance with the provisions of section (s) of the Fundamental Lease Provisions section of this Lease. Such payment 11/19/2007 illegal, invalid, or unenforceable, there be added as a part of this lease a clause or provision as similar in terms to such illegal, invalid or unenforceable clause or provision as may be possible and be legal, valid and enforceable. Section 32.24 RIGHT AND REMEDIES. The remedies of the Landlord shall be cumulative, and no one of them be construed as exclusive of the other or any remedy provided by law. The rights and remedies provided hereunder shall survive the termination of this Lease. Section 32.25 CORPORATE AUTHORITY Tenant represents and warrants that it has full 11/19/2007. . /IP/ .. . ..- , , •-•:,--- W-- . . ".', , , - e--.3, 3, _I-- ,3••,33:-.333v ---,. ,-; ....--f-3 I,,P• -i:.f:--.:,:..--:, ..r.,-- .'- . .-...„ . T.'.'''....f.....?' Attest NEBRASKA LIQUOR CONTROL COMMISSION t/rZ4 ji ,izo4L,t,‘___ It ilt114 Executive Director Chairman tI-iis , ',:-';-,'„ri.,'.7 XA,ti7SU„ffiiiolitFAVRTV-tatIKTIZIMINWA/aTilm, r RIVISsirrigiMP.rft ":5 ” s-,4A--.,Att.M141,*!,,-.. 2A-e • .'•5c,i, . .-47,_,. - ' :•-zi•-, •%, ;-,•;.;,vc•.: A''''.;7.4•4'47.,fr Y..i.v 4,a0067.4 vm orAtir.140-.-ty-.• vAv8v. ,,,', v,,,,,,, A-4-x,),-, .1.,4' . . , ",,ev ..,....,. 2,i,,,,:::,,,,...Avy.04::,,wkwy ,e,"44,Nkefa we.IviA,0,, *4=. ,.., ; •,-ft !:& 'Z'4-',k cf'4X, ;kli';'•• •4'g'-',''W5-...!f:'''',"..' : - 1W." . '',..;:r!.,,. "V..-4...,Ztat•:,!4'...e.••••Y: "....e,,,:s4-;/ •- •-. ' - ,:-_.•-•; . • „ Form 35-4100 Rev.1/04 % q m k , r) k 0 \ P e _ , ¢ 90 ^ @ 3 2 q • § g S 00 I. P n 0 2 P \ \ zii. m 7, 0 ) 9 7 � ' \` � q q ¢ 2 6 0, n " 22C q / n�. ? r' o ) P k J 2 p . ) n CD VD § Ch q m \ c - o k Fr ? t oo = Z ƒ E a § / o K — 2 \ § k - p m § - UTDOOR AREA APPROX 70' X 24' TO THE NORTH EXCLUDING IRREG-SHAPED AREA APPROX 19'X 25'TO THE SOUTH OFFICERS: PRES/MGR-PATRICIA FERGUSON * SECR - GENE FISHER