RES 2008-0134 - Appoint Michael Shadden manager of The Corner Pocket �_h 4p,
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STATE OF NEBRASKA
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#tea v 3, J
Dave Heineman NEBRASKA LIQUOR CONTROL COMMISSION
i or, '' Governor �y {�� .} p ��t1 tf Hobert B. Rupe
41 y9R..... 08 JAN —3 AM U• Yr U Executive Director
ta
301 Centennial Mall South,5th Floor
CITY C ) R K P.O.Box 95046
Lincoln,Nebraska 68509-5046
OMAHA, NEBRASKA 1 R A S A Phone(402)471-2571
Fax(402)471-2814
TRS USER 800 833-7352(TTY)
web address: http://www.lcc.ne.gov/
January 2, 2008
OMAHA CITY CLERK
1819 FARNAM STREET LC-1 •
OMAHA NE 68183
Dear Clerk:
Enclosed is a copy of a manager application for Michael Shadden in connection with
Corner Pocket Inc dba The Corner Pocket, located at 4201 S 38 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
er„,o,L)
e,1il .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
hed. 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
ISTANCE OF PROPOSED LICENSE TO ANY SCHOOL,CHURCH,OR CITY PARK: O _.
DISTANCE OF PROPOSED LICENSE TO ANY EXISTING LICENS .& -1'42 V 116A -l-z D.. '0,00 i
(State Law) DISTANCE OF P OPOSED LICENSE TO ANY CHURCH 0 1 6 ¢} 1
SCHOOL HOSPITAL U V IJOME FOR THE AGED,INDIGENT l ( ^1
OR VETERANS k__„....„..)ni,<Ois.A.i
(_' COLLEGE OR UNIVERSITY D 1------:-...._ 1
I ` l�k(Authorized Signature) (Date)
the demising wall between the original Leased Premises and the Additional Leased Premises (one to be
located within a couple of feet of the store front and the other to be located in the kitchen area) and to
touch up the paint. Notwithstanding any terms to the contrary herein, the terms and conditions of the
Lease shall apply to the Additional Leased Premises during Tenant's possession thereof prior to the
Effective Date except for any terms relating to the payment of Minimum Rent, Percentage Rent or any
additional rent. Any other construction by Tenant in the Additional Leased Premises shall require
Landlord's written approval as provided in the Lease. In the event the Effective Date does not
commence as provided in Section 6 of this Fourth Amendment, then Tenant shall immediately restore
the Additional Leased Premises to the same condition as prior to delivery of possession by removing
both doors and restoring the demising wall to its prior condition.
8. Except as otherwise provided herein, other terms and conditions of the Lease shall be
deemed to be incorporated herein and shall be part of this Fourth Amendment and shall continue in full
force and effect.
2
•- 'MANAGER APPLICATION Office Use
INSERT-FORM 3c
NEBRASKA LIQUOR CONTROL COMMISSION
301 CENTENNIAL MALL SOUTH
PO BOX 95046 �✓w✓
LINCOLN,NE 68509-5046 ��.S I
PHONE:(402)471-2571 , i ; nh
FAX:(402)471-2814 IUU f
Website:w�vw.lcc.ne.gov NE8H
r'.n1Vi'F?n1 nA,1MlUUFoIu ,'•
l'_
Corporate manager,including their spouse,are required to adhere to the following requirements iL
c.�
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
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 DEC 312001
Name of Corporation/LLC: The Corner Pocket, Inc.
re
Premise License Number: 7S615.
Premise Trade Name/DBA:The Corner Pocket
Premise Street Address:4201 S. 38 St.
City:Omaha State:NE
Zip Code:68107
Premise Phone Number: 1,(q— 7 ( (
t1 liU '7�,I�F.w •::fi[ti 4 I,+ p.'(� •ai .fi '4t1 , a,i[4a. ,:,• «II Is i„ i�i i?:� �i;'��1 Y };Y� ii .s r.• c4,1 rol' . O . ,.
!!! CORPORATE OFFICER SIGNATURE
(Faxed signatures are acceptable)
1111111111111111111
0700022134
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
ISTANCE OF PROPOSED LICENSE TO ANY SCHOOL,CHURCH,OR CITY PARK: O _.
DISTANCE OF PROPOSED LICENSE TO ANY EXISTING LICENS .& -1'42 V 116A -l-z D.. '0,00 i
(State Law) DISTANCE OF P OPOSED LICENSE TO ANY CHURCH 0 1 6 ¢} 1
SCHOOL HOSPITAL U V IJOME FOR THE AGED,INDIGENT l ( ^1
OR VETERANS k__„....„..)ni,<Ois.A.i
(_' COLLEGE OR UNIVERSITY D 1------:-...._ 1
I ` l�k(Authorized Signature) (Date)
the demising wall between the original Leased Premises and the Additional Leased Premises (one to be
located within a couple of feet of the store front and the other to be located in the kitchen area) and to
touch up the paint. Notwithstanding any terms to the contrary herein, the terms and conditions of the
Lease shall apply to the Additional Leased Premises during Tenant's possession thereof prior to the
Effective Date except for any terms relating to the payment of Minimum Rent, Percentage Rent or any
additional rent. Any other construction by Tenant in the Additional Leased Premises shall require
Landlord's written approval as provided in the Lease. In the event the Effective Date does not
commence as provided in Section 6 of this Fourth Amendment, then Tenant shall immediately restore
the Additional Leased Premises to the same condition as prior to delivery of possession by removing
both doors and restoring the demising wall to its prior condition.
8. Except as otherwise provided herein, other terms and conditions of the Lease shall be
deemed to be incorporated herein and shall be part of this Fourth Amendment and shall continue in full
force and effect.
2
r �xir'zr ^�' 'qv- u" { ®' Al, 9 1 E _ ! �;�[. rittl !
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Gender: [? MALE 0 FEMALE
DEC 3 1 1007
Last Name: Shadden First Name: Michael . NEBRASKla Ll
CONTROL COMMISSION
Home Address(include PO Box if applicable):5038 S. 86th Parkway, Apt. 9
Omaha
�'' state:NE Zip Code: 68127
Ci
Home Phone Number:N/A Business Phone Number: (402) 614-7111
Social Security Number: ( Drivers License Number& Stater i 1
Date Of Birth: ', ( Place Of Birth: Missouri Valley, IA
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Social Security Number: Drivers License Number& State:
Date Of Birth: ��_-1 Place Of Birth: �auNZ,t_ 5c.ALFFs r /4
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CITY&STATE YEAR CITY&STATE YEAR
FROM TO FROM TO
Omaha, NE 12/05 Presen &ayecc Bcu.F . /A- �1v7 /� .t
Council Bluffs, IA 11/04 12/05 e,Qpc,,,.,1E ,IE s/! s/v
Thurman, IA 2/01 11/04 e°`^ s3 ck FFS "4,0, °`
T1f,temAN PA eyo( rt70Y
Council Bluffs, IA 10/96 2/01
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YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER
FROM TO
2/07 Preset,, Upland Construction Terry Paulson a: — 4 7
9/06 11/06 Premier Communications Dan ,fA
•
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4NEEIMTh
I. READ PARAGRAPH CAREFULLY AND ANSWER COMPLETELY AND ae3WINh 01,
SSinn:
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.
YES ONO If yes,please explain below or attach a separate page.
ApplIea...a' waa Clair, w:s . laS7oS$Pon of draj /oa-e9,1"."-Acchcd Gn • Suer 02o0 7
(('p Y /Fa .ems df ,deo) .4 h(a4 f/€a Qu /f�*� ,r_e �. fled a °dee.a, `h`iui
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 XNO
3. Do you,as a manager,have all the qualifications required to hold a Nebraska Liquor License? Nebraska
Liquor Control Act(§53-131.01)
)RIYES 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)
OYES LINO
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Spouses Last Name: 5444. ,d First Name: wlewoy
MI: J
Social Security Number: Drivers License Number& State:
Date Of Birth: ��_-1 Place Of Birth: �auNZ,t_ 5c.ALFFs r /4
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CITY&STATE YEAR CITY&STATE YEAR
FROM TO FROM TO
Omaha, NE 12/05 Presen &ayecc Bcu.F . /A- �1v7 /� .t
Council Bluffs, IA 11/04 12/05 e,Qpc,,,.,1E ,IE s/! s/v
Thurman, IA 2/01 11/04 e°`^ s3 ck FFS "4,0, °`
T1f,temAN PA eyo( rt70Y
Council Bluffs, IA 10/96 2/01
�a n.Cr c. B,..,„s ��/96 �/o
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YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER
FROM TO
2/07 Preset,, Upland Construction Terry Paulson a: — 4 7
9/06 11/06 Premier Communications Dan ,fA
:v . ..
RECEI
ly' �1ti d � 4� i'Z
\31✓�C • t°s i•C 1*
T TT { �"
... .A• .• r
The above individual(s), being first duly sworn upon oath,deposes and states that the undersignect afdlS*ce 4 or spouse
•
of applicant who makes the above and foregoing application that said application has been reaRgitiNirib 1l eof and
all statements contained therein are true. If any false statement is made in any part of this application,the applican s)'hall 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 Applicant Signature of Spouse
State of Nebraska
County of btxad-6,4) County of
The foregoing instrument was acknowledged before The foregoing instrument was acknowledged before
me this ,5 - /fisveir - by me this by
/07/ctiae/ ,.SXQda�e,
ota u lic s' Notary Public signature
•
Affix Seal re
I • Affix Seal Here
�•r,
• THOMAS C.GREEN II
f.ee.r.�:1.1 MY COMMISSION EXPIRES
wOt A.
•••r igt June 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
...,..�•s..�V �= P'
Spouses Last Name: 5444. ,d First Name: wlewoy
MI: J
Social Security Number: Drivers License Number& State:
Date Of Birth: ��_-1 Place Of Birth: �auNZ,t_ 5c.ALFFs r /4
..} x10 . £-4. ya,44 k1 r .v t J,r.tD rx..E�'_4 w, S '�,qq
6'd"� , e i h 'f"{z Q i> Al� y,3 gn "� ,b. { ? . r 1 r I y t u °'„
a. ' D�' v g Ok err- -' .",', oti E 'r`'' "fli „' a> tt'.? A M -) ,SI 'r. , `pC. .+§
tsa5�i,, ,l'�r�G. itriukit .n.. .ram ;� I �.. .� :,a�. 1!+ .''S lF I
CITY&STATE YEAR CITY&STATE YEAR
FROM TO FROM TO
Omaha, NE 12/05 Presen &ayecc Bcu.F . /A- �1v7 /� .t
Council Bluffs, IA 11/04 12/05 e,Qpc,,,.,1E ,IE s/! s/v
Thurman, IA 2/01 11/04 e°`^ s3 ck FFS "4,0, °`
T1f,temAN PA eyo( rt70Y
Council Bluffs, IA 10/96 2/01
�a n.Cr c. B,..,„s ��/96 �/o
�F' ` ' }�r+'i r'e �Y„q�Kam ri " r '!_ r 3m 3..= m � ,w r -
: 4.w.L'.. b, ."tliile fl'4, ,ti,`��1 �,, � .,risrzi,r p , ,,,, ...a-'r;lw 11 Nit b: S 6£� .n"Y Mw.;+!*Mi 3 it u y � N '.. �.. ,.,.aa '2"�.,u �,>,
YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER
FROM TO
2/07 Preset,, Upland Construction Terry Paulson a: — 4 7
9/06 11/06 Premier Communications Dan ,fA
City of Omaha, fAlebras&aMire).-.4%(Piri
1819 Farnam—Suite LC 1 2 f d �,
Omaha, Nebraska 68183-0112 0 1� _:, �'
Buster Brown (402) 444-5550 .o esi
City Clerk FAX (402) 444-5263 o '7'ED F0BRv44�
January 15, 2008
The Corner Pocket, Inc. Application to appoint Michael Shedden
Dba "The Corner Pocket" manager of your present Class "C"
4201 South 38th Street Liquor License
Omaha, NE 68107
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 29,
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
on, is
subject to cancellation if the information contained herein is incomplete,inaccurate,or fraudulent.
•
Signature of Manager Applicant Signature of Spouse
State of Nebraska
County of btxad-6,4) County of
The foregoing instrument was acknowledged before The foregoing instrument was acknowledged before
me this ,5 - /fisveir - by me this by
/07/ctiae/ ,.SXQda�e,
ota u lic s' Notary Public signature
•
Affix Seal re
I • Affix Seal Here
�•r,
• THOMAS C.GREEN II
f.ee.r.�:1.1 MY COMMISSION EXPIRES
wOt A.
•••r igt June 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
...,..�•s..�V �= P'
Spouses Last Name: 5444. ,d First Name: wlewoy
MI: J
Social Security Number: Drivers License Number& State:
Date Of Birth: ��_-1 Place Of Birth: �auNZ,t_ 5c.ALFFs r /4
..} x10 . £-4. ya,44 k1 r .v t J,r.tD rx..E�'_4 w, S '�,qq
6'd"� , e i h 'f"{z Q i> Al� y,3 gn "� ,b. { ? . r 1 r I y t u °'„
a. ' D�' v g Ok err- -' .",', oti E 'r`'' "fli „' a> tt'.? A M -) ,SI 'r. , `pC. .+§
tsa5�i,, ,l'�r�G. itriukit .n.. .ram ;� I �.. .� :,a�. 1!+ .''S lF I
CITY&STATE YEAR CITY&STATE YEAR
FROM TO FROM TO
Omaha, NE 12/05 Presen &ayecc Bcu.F . /A- �1v7 /� .t
Council Bluffs, IA 11/04 12/05 e,Qpc,,,.,1E ,IE s/! s/v
Thurman, IA 2/01 11/04 e°`^ s3 ck FFS "4,0, °`
T1f,temAN PA eyo( rt70Y
Council Bluffs, IA 10/96 2/01
�a n.Cr c. B,..,„s ��/96 �/o
�F' ` ' }�r+'i r'e �Y„q�Kam ri " r '!_ r 3m 3..= m � ,w r -
: 4.w.L'.. b, ."tliile fl'4, ,ti,`��1 �,, � .,risrzi,r p , ,,,, ...a-'r;lw 11 Nit b: S 6£� .n"Y Mw.;+!*Mi 3 it u y � N '.. �.. ,.,.aa '2"�.,u �,>,
YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER
FROM TO
2/07 Preset,, Upland Construction Terry Paulson a: — 4 7
9/06 11/06 Premier Communications Dan ,fA
�OFNit ,PCit o Omaha Nebras a 'e
1819 Farnam—Suite LC 1 Lt -^"�
0�
Omaha, Nebraska 68183-0112 a �
Buster Brown (402) 444-5550 .o
City Clerk FAX (402) 444-5263 o 'TtD fiEe80*��
January 15, 2008
Michael Shedden Application to be appointed manager of the present
5038 South 86th Pkwy, Apt#9 Class "C" Liquor License for The Corner Pocket,
Omaha, NE 68127 Inc., dba"The Corner Pocket", 4201 South 38th 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
29, 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
in is incomplete,inaccurate,or fraudulent.
•
Signature of Manager Applicant Signature of Spouse
State of Nebraska
County of btxad-6,4) County of
The foregoing instrument was acknowledged before The foregoing instrument was acknowledged before
me this ,5 - /fisveir - by me this by
/07/ctiae/ ,.SXQda�e,
ota u lic s' Notary Public signature
•
Affix Seal re
I • Affix Seal Here
�•r,
• THOMAS C.GREEN II
f.ee.r.�:1.1 MY COMMISSION EXPIRES
wOt A.
•••r igt June 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
...,..�•s..�V �= P'
Spouses Last Name: 5444. ,d First Name: wlewoy
MI: J
Social Security Number: Drivers License Number& State:
Date Of Birth: ��_-1 Place Of Birth: �auNZ,t_ 5c.ALFFs r /4
..} x10 . £-4. ya,44 k1 r .v t J,r.tD rx..E�'_4 w, S '�,qq
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CITY&STATE YEAR CITY&STATE YEAR
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Omaha, NE 12/05 Presen &ayecc Bcu.F . /A- �1v7 /� .t
Council Bluffs, IA 11/04 12/05 e,Qpc,,,.,1E ,IE s/! s/v
Thurman, IA 2/01 11/04 e°`^ s3 ck FFS "4,0, °`
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Council Bluffs, IA 10/96 2/01
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YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER
FROM TO
2/07 Preset,, Upland Construction Terry Paulson a: — 4 7
9/06 11/06 Premier Communications Dan ,fA
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