RES 2021-0548 - Appoint Sarah E Cooper manager of Throwback Acrade Lounge E-MAILED TO NLCC / 7,220,2 I
srgTFo
to," STATE OF NEBRASKA
,(64r „;d Pete Ricketts NEBRASKA LIQUOR CONTROL COMMISSION
'ZIP Governor Hobert B.Rupe
Executive Director
V 4gKcra 301 Centennial Mall South,5ih Floor
P.O.Box 95046
Lincoln,Nebraska,68509-5046
• Phone(402)471-2571
• Fax(402)471-2814 or(402)471-2374
. TSR USER 800-833-7252(TTY)
• Web Address http://www.lcc.nebraska.gov/
Today's Date: April 05, 2021 •
From: Lisa Steward
To: City Clerk of Omaha •
•
I have attached a copy of a new corporate manager application submitted to the Nebraska
Liquor Control Commission. Please complete the following information below to indicate
your recommendation.
Licensee Name: Throwback Empire LLC
Trade Name(DBA): Throwback Arcade Lounge
•
License Number: C 123075
Manager Name: Cooper, Sarah E
Due Date: May 20, 2021
APPROVED
•
El NO LOCAL RECOMMENDATION
DENIED
COMMENTS: (YOU MAY ATTACH Mi MUTES AND/OR ADDITIONAL NOTES)
34 2V21- D� ,N . , 2
•
Clerk's Name: • ��Date: ' I _ ? '
-•
•
•
Janice M.Wiebusch Bruce Bailey Harry Hoch
Commissioner Chairman Commissioner
•
A Equal Opportunity Employer
j
MANAGER APPLICATION office use
INSERT-FORM 3c RECEIVED
NEBRASKA LIQUOR CONTROL COMMISSION
301 CENTENNIAL MALL SOUTH
PO BOX 95046 APR 05 2021
LINCOLN,NE 68509-5046
PHONE:(402)471-2571 NEBRASKA LIQUOR
FAX:(402)471-2814 CONTROL COMMISSION
Website:www.Icc.nebraska.gov
FORM MUST BE COMPLETELY FILLED OUT IN ORDER FOR APPLICATION TO BE
PROCESSED
MANAGER MUST:
„_.A. Complete all sections of the application. Be sure it is signed by a member or corporate officer,
corporate officer or member must be an individual on file with the Liquor Control Commission
• Fingerprints are required. See form 147 for further information, read form carefully to avoid delays
in processing, this form MUST be included with your application.
„ • Provide a copy of one of the following: US birth certificate, naturalization papers or current US
passport(even if you have provided this before)
• Be a registered voter in the State of Nebraska, include a copy of voter card or print document from
Secretary of State website with application
-Arri‘,r•
Spouse who will not participate in the business, spouse must:
• Complete the Spousal Affidavit of Non Participation Insert(must be notarized). The non-
, �(�- participating spouse completes the top half; the manager completes the bottom half. Be sure to
�,j complete both halves of this form.
• Need not answer question#1 of the application
Spouse who will participate in the business,the spouse must:
• Sign the application
• Fingerprints are required. See form 147 for further information, read form carefully to avoid delays
in processing,this form MUST be included with your application.
\NJ.' • Provide a copy of one of the following:birth certificate,naturalization papers or current US passport
(even if you have provided this before)
• Be a registered voter in the state of Nebraska, include a copy of voter card with application
• Spousal Affidavit of Non Participation) Insert not required
2100003589 Form 103
Rev July 2018
Page 1 ot6
•
MANAGER APPLICATION • Office Use
•
INSERT-FORM 3c FtFCEIVED
NEBRASKA LIQUOR CONTROL COMMISSION
301 CENTENNIAL MALL SOUTH n )y', 0 5 02:
PO BOX 95046
LINCOLN,NE 68509-5046 S ;
PHONE:(402)471-2571
FAX:(402)471-2814 CONTROL OlvlivliSSION
Website:www.lcc.nebraska.gov -
MUST BE:
✓ Include copy of US birth certificate,naturalization paper or current US passport
Nebraska resident. Include copy of voter registration card or print out document from
I Fingerprinted. See form 147 for further information,read form carefully to avoid delays in
processing,this form MUST be included with your application
✓ 21 years of age or older
Corporation/LLC information
Throwback Empire, LLC
Name of Corporation/LLC:
Premise information
123075 C
Liquor License Number: Class Type (if new application leave blank)
Throwback Arcade Lounge
Premise Trade Name/DBA:
1402 Howard Street
Premise Street Address:
Omaha Douglas 68102
City: County: Zip Code:
531-466-3851
Premise Phone Number:
info@throwbackarcadelounge.com
Premise Email address:
The individual whose name is listed as a corporate officer or managing member as reported on insert
form 3a or 3b or listed with the Commission. To see authorized officers or members search your license
information t,
, ,I
SIGNAT RE REQUIRM BY CORPORATE OFFICER/MANAGING MEMBER
(Faxed signatures are acceptable)
e,.m, i nT
ngerprints are required. See form 147 for further information, read form carefully to avoid delays
in processing,this form MUST be included with your application.
\NJ.' • Provide a copy of one of the following:birth certificate,naturalization papers or current US passport
(even if you have provided this before)
• Be a registered voter in the state of Nebraska, include a copy of voter card with application
• Spousal Affidavit of Non Participation) Insert not required
2100003589 Form 103
Rev July 2018
Page 1 ot6
Manager's information must be completed below PLEASE PRINT CLEARLY
Cooper Sarah E
Last Name: First Name: MI:
3811 South 182nd Street
Home Address:
Omaha Douglas • 68130
City: • County: Zip Code:
402-659-2082
Home Phone Number:
liMDriver's License Number& Stat .
Social Securi Number.
Date Of Birth: Place Of Birth:Omaha
sarahecooper402@gmail.com
Email address:
Are you married? If yes, complete spouse's information(Even if a spousal affidavit has been submitted)
❑ YES Q NO
Spouse's information
Spouses Last Name: First Name: MI:
Social Security Number:
Driver's License Number& State:
Date Of Birth: Place Of Birth:
APPLICANT& SPOUSE MUST LIST RESIDENCE(S)FOR THE PAST TEN(10)YEARS
APPLICANT SPOUSE
CITY& STATE FROM CITY& STATE • FYROM EAR AR
Omaha, NE 2014 2021
San Diego, CA 2012 2013
Lincoln, NE 2009 2012
J rm 1A
ress:
Omaha Douglas 68102
City: County: Zip Code:
531-466-3851
Premise Phone Number:
info@throwbackarcadelounge.com
Premise Email address:
The individual whose name is listed as a corporate officer or managing member as reported on insert
form 3a or 3b or listed with the Commission. To see authorized officers or members search your license
information t,
, ,I
SIGNAT RE REQUIRM BY CORPORATE OFFICER/MANAGING MEMBER
(Faxed signatures are acceptable)
e,.m, i nT
ngerprints are required. See form 147 for further information, read form carefully to avoid delays
in processing,this form MUST be included with your application.
\NJ.' • Provide a copy of one of the following:birth certificate,naturalization papers or current US passport
(even if you have provided this before)
• Be a registered voter in the state of Nebraska, include a copy of voter card with application
• Spousal Affidavit of Non Participation) Insert not required
2100003589 Form 103
Rev July 2018
Page 1 ot6
•
MANAGER'S LAST TWO EMPLOYERS
FROM A TO NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER
2017 2021 Top Shelf Strategies Self-Employed 402-659-2082
2014 2021 Parliament Pub Mike Miller 402-650-2909
1. READ CAREFULLY. ANSWER COMPLETELY AND ACCURATELY.
Must be completed by both applicant and spouse, unless spouse has filed an affidavit of non-
participation.
ation.P
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, include traffic violations. Also list any charges pending at the time of this application. If more than one party,
please list charges by each individual's name. Commission must be notified of any arrests and/or convictions that may
occur after the date of signing this application.
[2n YES ❑ NO
If yes,please explain below or attach a separate page.
Date of Where Description
Name of Applicant Conviction Convicted of Disposition
(mm/yyyy) (City&State) Charje
Sarah Cooper 11/2012 San Diego Speeding Guilty
•
2. Have you or your spouse ever been approved or made application for a liquor license in Nebraska or
any other state?
DYES ONO
IF YES,list the name of the premise(s):
3. Do you, as a manager, qualify under Nebraska Liquor Control Act and do you intend to
supervise, in person, the management of the business?
OYES ONO
• F,rm 1fE
J.' • Provide a copy of one of the following:birth certificate,naturalization papers or current US passport
(even if you have provided this before)
• Be a registered voter in the state of Nebraska, include a copy of voter card with application
• Spousal Affidavit of Non Participation) Insert not required
2100003589 Form 103
Rev July 2018
Page 1 ot6
4. List the alcohol related training and/or experience(when and where)of the person making application.
*NLCC Training Certificate Issued: Name on Certificate:
•
Date
Applicant Name (myyyy) Name of program(attach copy of course completion
certificate)
*For list of NLCC Certified Training Programs see training
Experience:
Applicant Name/Job Title Date of Name&Location of Business:
Employment:
VIP Host/Marketing Manager 11/2020 Throwback Arcade Lounge (1402 Howard Street)
Bartender/Marketing Manage 1/2014. Parliament Pub (16939 Wright Plaza)
Marketing Manager 8/2017 Top Shelf Strategies
Bartender 12/2013 EZ Place (15761 W Dodge Road)
Bartender 9/2012 Anejos (329 W Felicita Avenue)
5. Have you enclosed form 147 regarding fingerprints? •
OYES []NO
• Pn.n,t ni
n must be notified of any arrests and/or convictions that may
occur after the date of signing this application.
[2n YES ❑ NO
If yes,please explain below or attach a separate page.
Date of Where Description
Name of Applicant Conviction Convicted of Disposition
(mm/yyyy) (City&State) Charje
Sarah Cooper 11/2012 San Diego Speeding Guilty
•
2. Have you or your spouse ever been approved or made application for a liquor license in Nebraska or
any other state?
DYES ONO
IF YES,list the name of the premise(s):
3. Do you, as a manager, qualify under Nebraska Liquor Control Act and do you intend to
supervise, in person, the management of the business?
OYES ONO
• F,rm 1fE
J.' • Provide a copy of one of the following:birth certificate,naturalization papers or current US passport
(even if you have provided this before)
• Be a registered voter in the state of Nebraska, include a copy of voter card with application
• Spousal Affidavit of Non Participation) Insert not required
2100003589 Form 103
Rev July 2018
Page 1 ot6
PERSONAL OATH AND CONSENT OF INVESTIGATION
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. 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.
Applicant Notification and Record Challenge: Your fingerprints will be used to check the criminal history.
records of the FBI. You have the opportunity to complete or challenge the accuracy of the information
contained in FBI identification record. The procedures for obtaining a change, correction, or updating an
FBI identification record are set forth in Title 28, CFR, 16.34.
Signature of Manager Applicant Signature of Spouse
•
ACKNOWLEDGEMENT
State of Nebraska
County of The foregoing instrument was acknowledged before me this
_ by
date NAME OF PERSON BEING ACKNOWLEDGED
Affix Seal
Notary Public signature
is available in other formats for persons with disabilities.
In compliance with the ADA,this application
A ten day advance period is required in writing to produce the alternate format.
Fnrm 1111 I',
PRIVACY ACT STATEMENT/
SUBMISSION OF FINGERPRINTS/ RECENED
PAYMENT OF FEES TO NSP-CID
NEBRASKA LIQUOR CONTROL COMMISSION ` 202i
301 CENTENNIAL MALL SOUTH NEBRASKA LIQUOR
PO BOX 95046
LINCOLN,NE 68509-5046 CONTROL COMMISSION
PHONE: (402)471-2571
FAX: (402)471-2814
THIS FORM IS REQUIRED TO BE SIGNED BY EACH PERSON BEING FINGERPRINTED:
DIRECTIONS FOR SUBMITTING FINGERPRINTS AND FEE PAYMENTS:
• FAILURE TO FILE FINGERPRINT CARDS AND PAY THE REQUIRED FEE TO THE
NEBRASKA STATE PATROL WILL DELAY THE ISSUANCE OF YOUR LIOUOR LICENSE
• Fee payment of S45.25 per person MUST be made DIRECTLY to the Nebraska State Patrol;
It is recommended to make payment through the NSP PayPort online system at
Or a check made payable to NSP can be mailed directly to the following address:
***Please indicate on your payment who the payment is for(the name of the person being
fingerprinted)and the payment is for a Liquor License***
The Nebraska State Patrol—CID Division
3800 NW 12th Street
Lincoln,NE 68521
• Fingerprints taken at NSP LIVESCAN locations will be forwarded to NSP—CID
Applicants) will not have cards to include with license application.
• Fingerprints taken at local law enforcement offices may be released to the applicants;
Fingerprint cards should be submitted with the application.
Applicant Notification and Record Challenge: Your fingerprints will be used to check the criminal history
records of the FBI. You have the opportunity to complete or challenge the accuracy of the information
contained in the FBI identification record The procedures for obtaining a change, correction, or updating
a FBI identification record are set forth in Title 28, CFR, 16.34.
****Please Submit this form with your completed application to the Liquor Control Commission****
Trade Name nr°Wback Arcade Lounge
Name of Person Bein Fin erprinted: Sarah Cooper
Date of Birth: Last 4 SSN:
Date fingerprints were taken: [M,/AVM 2 (14 2021
Location where fingerprints were taken: LI q it ). i(}6e' tiTC-
How was payment made to NSP?
iSP PAYPORT ❑CASH ❑CHECK SENT TO NSP CK#
My fingerprints are already on file with the commission—fingerprints completed for a previous
application Ile than- years ago? YES ❑
SIGNATURE IRED 0 ERSON BEING F ERPRINTED
4/20/2021 Enterprise Mail-MANAGER'S APPLICATION-RESCHEDULE
G ;il Carman Johnson (CCIk) <carman.johnson@cityofomaha.org>
MANAGER'S APPLICATION - RESCHEDULE
1 message
Carman Johnson (CCIk) Tue, Apr 20, 2021 at 12:15
<Carman.Johnson@cityofomaha.org> PM
To: Sarah Cooper <SARAHECOOPER402@gmail.com>, BREANNAC06@gmail.com
Bcc: "Elizabeth Butler (CCIk)" <elizabeth.butler@cityofomaha.org>, "Kimberly Hoesing
(CCIk)" <kimberly.pulliam@cityofomaha.org>
Good afternoon
RE: THROWBACK EMPIRE, LLC
Per the City Council Law Committee meeting the manager's
application to appoint Sarah Cooper has been rescheduled to
May 18, 2021 at 2:00 p.m. you are required to attend this
meeting.
You do not have to attend the April 27th meeting.
Please notify me if you have any questions.
Thanks
Carman Johnson
Liquor Clerk
City of Omaha/City Clerk
1819 Farnam Street
Suite LC-1
Omaha, NE 68183
402-444-5324
402-444-5263 fax
Carman.johnson@cityofomaha.org
https://mai l.google.com/mai I/u/0?ik=cd387c45eb&view=pt&search=all&permthid=thread-a%3Ar-7057996614833836839%7Cmsg-a%3Ar45872851217... 1/2
P—CID
Applicants) will not have cards to include with license application.
• Fingerprints taken at local law enforcement offices may be released to the applicants;
Fingerprint cards should be submitted with the application.
Applicant Notification and Record Challenge: Your fingerprints will be used to check the criminal history
records of the FBI. You have the opportunity to complete or challenge the accuracy of the information
contained in the FBI identification record The procedures for obtaining a change, correction, or updating
a FBI identification record are set forth in Title 28, CFR, 16.34.
****Please Submit this form with your completed application to the Liquor Control Commission****
Trade Name nr°Wback Arcade Lounge
Name of Person Bein Fin erprinted: Sarah Cooper
Date of Birth: Last 4 SSN:
Date fingerprints were taken: [M,/AVM 2 (14 2021
Location where fingerprints were taken: LI q it ). i(}6e' tiTC-
How was payment made to NSP?
iSP PAYPORT ❑CASH ❑CHECK SENT TO NSP CK#
My fingerprints are already on file with the commission—fingerprints completed for a previous
application Ile than- years ago? YES ❑
SIGNATURE IRED 0 ERSON BEING F ERPRINTED
4/6/2021 Enterprise Mail-MANAGER'S APPLICATION FOR OMAHA CITY COUNCIL HEARIN G
. - - ? maii Carman Johnson (CCIk) <carman.johnson@cityofomaha.org>
MANAGER'S APPLICATION FOR OMAHA CITY COUNCIL
HEARIN G
1 message
Carman Johnson (CCIk) Tue, Apr 6, 2021 at 10:11
<Carman.Johnson@cityofomaha.org> AM
To: Sarah Cooper <SARAHECOOPER402@gmail.com>, BREANNAC06@gmail.com
Bcc: "Elizabeth Butler (CCIk)" <elizabeth.butler@cityofomaha.org>, "Kimberly Hoesing
(CCIk)" <kmberly.pulliam@cityofomaha.org>
Good Morning
RE: THROWBACK EMPIRE, LLC
The Omaha City Clerk's Office has received your application from the Nebraska Liquor
Control Commission. The Omaha City Council will hold a public hearing on this request
on Tuesday, APRIL 27, 2021. City Council meetings start at 2:00 PM and are located in
the Legislative Chambers in the Omaha/Douglas County Building located at 1819
Farnam Street, Omaha, NE 68183. You or a representative is required to attend the
meeting.
I ALSO NEED THE DATE OF BIRTH FOR SARAH E COOPER, PLEASE SEND ME
THIS INFORMATION AS SOON AS POSSIBLE.
Please notify me if you have any questions.
Thanks
Carman Johnson
Liquor Clerk
City of Omaha/City Clerk
1819 Farnam Street .
Suite LC-1
Omaha, NE 68183
402-444-5324
402-444-5263 fax
https://mai I.google.com/mail/u/0?ik=cd387c45eb&view=pt&search=al!&permthid=thread-a%3Ar-74137674285416163%7Cmsg-a%3Ar6261573630885... 1/2
riminal history
records of the FBI. You have the opportunity to complete or challenge the accuracy of the information
contained in the FBI identification record The procedures for obtaining a change, correction, or updating
a FBI identification record are set forth in Title 28, CFR, 16.34.
****Please Submit this form with your completed application to the Liquor Control Commission****
Trade Name nr°Wback Arcade Lounge
Name of Person Bein Fin erprinted: Sarah Cooper
Date of Birth: Last 4 SSN:
Date fingerprints were taken: [M,/AVM 2 (14 2021
Location where fingerprints were taken: LI q it ). i(}6e' tiTC-
How was payment made to NSP?
iSP PAYPORT ❑CASH ❑CHECK SENT TO NSP CK#
My fingerprints are already on file with the commission—fingerprints completed for a previous
application Ile than- years ago? YES ❑
SIGNATURE IRED 0 ERSON BEING F ERPRINTED
4/6/2021 Enterprise Mail-MANAGERS APPLICATION FOR OMAHA CITY COUNCIL HEARIN G
Carman.johnson@cityofomaha.org
•
•
•
hops://mail.google.com/mail/u/0?ik=cd387c45eb&view=pt&search=all&permthid=thread-a%3Ar-74137674285416163%7Cmsg-a%3Ar6261573630885... 2/2