RES 2007-0595 - Appoint Gail Ward manager of Kobe Steak House of Japan _ ,SHE STA TN 4 }
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: � C STATE OF NEBRASKA
Dave Heineman NEBRASKA LIQUOR CONTROL COMMISSION
''a(r_ Governor C it 16 r 14 4.1 Hobert B. Rupe
Executive Director
301 Centennial Mall South,5th Floor
CITY CLERK P.O.Box 95046
L,i M A}{ ,, N E B B i S K,/ 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/
April 13, 2007
Omaha City Clerk
1819 Farnam Street LC1
Omaha, NE 68183
Dear Clerk:
Enclosed is a copy of a manager application for Gail Ward in connection with Kobe of
Omaha Inc dba Kobe Steak House of Japan, located at 120 Regency Parkway, Omaha
NE.
Please present this application for manager to your Council and send us the results of
their action. •
• Sincerely,
NEBRASKA LIQUOR CONTROL COMMISSION
C601\-)
Jeri Cash
Licensing Division
•
jc
encl.
cc: file
•
•
Rhonda R. Flower Bob Logsdon R.L. (Dick) Coyne
Commissioner Chairman Commissioner
An Equal Opportunity/Affirmative Action Employer
Printed with soy ink on recycled paper
o.
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 •
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Form 35-4100 Rev.1/04
. Application for Corporate Manager
*Must Be A Nebraska Resident* RECEIVED
Please submit in Triplicate
Return to: Nebraska Liquor Control Commission,PO Box 95046
301 Centennial Mall So.,Lincoln NE 68509 MAR 2 12007
Phone:(402)471-2571 Fax: 402)471 2814 Web address:h .://www.nolo _ i ome/NLCC/
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NAME OF LICENSED CORPORATION CLASS&LICENSE NUMBER M, ON
kdOE 01 Oft IZ r 57 1`i I
TRADE NAME OF LICENSED PREM E
kB 'Ca/It / odse 64 BRA
STREET ADDRESS OF LICENSED Pp4ISE CITY COUNTY ZIP CODE
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�D �f 0 CAI G� /A"gZ'u/Q� Ois9d IN V.)00 ,4I¢S 6 . 1 I(/
On behalf of the corporation,I designate this individual as corporate ni
Cam-. `
Signature of Corporate President/CEO:
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NAME(LAST,FIRST,MIDDLE,MAIDEN) e5X SOCIAL SECURITY NUMBER DATE OF BIRTHPLACE OF BIRTH
M
HOME STREET ADDRESS 1 CITY COUNTY STATE ZIP CODE
501/0 S 4 /6 9Sj- of'"(l hto 3 5- O mom.i)\ po ot,Q s XI 6.gl3
HOME TELEPHONE NUMBER BUSINESS TELEPHONE UMBER DRIVERS LICENSE NUMBER&STATE
( 02) Ng2- • 325-0 ( ,/o2) 39/-/755 .v'
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FULL NAME(LAST,FIRST,MIDDLE,MAIDEN)},, SOCIAL SECURITY NUMBER DRIVERS LICENSE NUMBER
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DATE OF BIRTH: PLACE OF BIRTH 0 N7(,C t'?a
I. READ CAREFULLY. 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 criminal charge. Criminal
charge means any charge alleging a felony or misdemeanor violation of a federal or state law;or 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 pend'ing�at the time of this application. If more than one party,please list charges by each individual's name.
CI Yes o
2. Have you or your spouse ever made application for any liquor license or manager for any liquor license? IF YES,for what premise give
license number and date.
DYES ... XNO '
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FORM 35-4013
2/01
0700007079 REV PAGE1
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3. Have you or your spouse ever made a compromise settlement for violation of such laws?
OYES10
4. Do you,as a manager,have all the qualifications required by any person entitled to hold a Nebraska Liquor License?
Nebraska Liquor Control Act(§53-131.01)
YES ONO
5. Have you filed fingerprint cards and PROPER FEES(if check,make out to the NE State Patrol),with this application?
' YES ONO 0'64\A, ErAdos )
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APPLICANT:CITY&STATE YEAR SPOUSE:CITY&STATE YEAR
FROM TO FROM TO
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YEARO NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER
FROM TO
the r-0(s ere f y(p► °. SA X � '^5 G you?/ 144.111 3 V /7 5-.5-
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STATE OF NEBRASKA )
) SS
COUNTY OF )
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,an affidavit may be attached,however,fingerprint cards are still required to be filed.
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 and inaccurate.
W
Signature of Applicant Sig of Spou (If applicable)
Subscribed i m resence an swo to before me this 1 6P Subscribed tiRy presence and sworn to before me this /'(p
day of day of Lir M.frlci!)1ZIk7 GENERAL NOTARY-State of Nebraska
ERA1 NOTARY-State teLf Nebraska
BONNIE ALLEN BONNIE ALLEN
M/k.e.0 O�Q(1 , ) ` My Comm.Exp.May 30,2010 C��� 00,0(4A..-1
-� My Comm.Exp.May 30,2010
lNotaryy✓Si`gnnaature&Seal Notary Signature&Seal
FORM 354013
REV.2/01
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Form 35-4100 Rev.1/04
RECEIVED
NEBRASKA LIQUOR CONTROL COMMISSION f�A�i 2001
AFFIDAVIT OF NON PARTICIPATION NEBRASKA LIQUOR
CONTROL COMMISSION
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. Undersigned will also be waived of filing finge 'nt cards,however,has disclosed any
violation(s)on plication. f
r
(-r .,;e •
Signatur of Spouse
SUBSCRIBED in my presence and sworn to before me this i 10 day of
____ ___________ _ _._____ 46.___ __ _al ._xA._. _
GpiEAAI NOTARY-State of Nebraska
BONNIE ALLEN Signature of Notary Public
My Comm.Up.May 30.2010
The licensee/applicant 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.
����i� erg; I 1., ccJc��1
Signature of Licensee/Applicant Print Name of Licensee/Applicant
SUBSCRIBED in my presence and sworn to before me this / I p day of
'-7 CLILCJ , r (:)n-') .
G PEAAL NOTARY-State of Nebraska C��"`'
BONNIE ALLEN `��
...k. My Comm.Exp.May 30,2010
Signature of Notary Public
FORM 35-4178
REV 2/01
plaid an nodded ppr
emed 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,an affidavit may be attached,however,fingerprint cards are still required to be filed.
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 and inaccurate.
W
Signature of Applicant Sig of Spou (If applicable)
Subscribed i m resence an swo to before me this 1 6P Subscribed tiRy presence and sworn to before me this /'(p
day of day of Lir M.frlci!)1ZIk7 GENERAL NOTARY-State of Nebraska
ERA1 NOTARY-State teLf Nebraska
BONNIE ALLEN BONNIE ALLEN
M/k.e.0 O�Q(1 , ) ` My Comm.Exp.May 30,2010 C��� 00,0(4A..-1
-� My Comm.Exp.May 30,2010
lNotaryy✓Si`gnnaature&Seal Notary Signature&Seal
FORM 354013
REV.2/01
PAGE 2
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SUCH RULES ND REGULATIONS AS
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TENANT: FDS, LLC
BY:
Robert Linstroth, Manager
LANDLORD: FARRELL'S DODGE, LLC
BY:
Robert Linstroth,Manager
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