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RES 2007-0667 - Appoint Hong Zheng manager of China Buffet . • RECEIVED STATE OF NEBRASKA r y' Dave Heineman �` / ° �° Governor NEBRASKA LIQUOR CONTROL COMMISSION '\ ,..,�,_ 07 tiny �.9 R 8 42 Hobert B. Rupe "`\ R i Executive Director 301 Centennial Mall South,5th Floor CITY CLERK P.O.Box 95046 O M A H A 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/ May 7, 2007 Omaha City Clerk 1819 Farnam Street LC1 Omaha, NE 68183 Dear Clerk: • Enclosed is a copy of a manager application for Hong Zheng in connection with Hong's Inc II dba China Buffet, located at 3605 N 147th 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 efizk) 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 • cancellation if the information. contained herein is incomplete,inaccurate,or fraudulent. 1 b./' Signature of Applicant Signature of Spouse 511 Subscribed in my presence and sworn to before me this Subscribed in my presence and sworn to before me this day of April 2007 . day of /--/ . A7/' Notary Signature&Seal Notary Signature&Seal ENERAL NOTARY-State of Nebraska ii 11, KAREN K. FISHER A. My Comm.Exp.Jan.21,2010 FORM 35-4013 REV.4/05 RECEIVED APPLICATION FOR LIQUOR LICENSE CORPORATION MANAGER- FORM 3b APR 19 2C07 *MUST BE A NEBRASKA RESIDENT* NEBRAso LIQUOR 301 CENTENNIAL MALL SOUTH CONTROL COMN fSSION PO BOX 95046 LINCOLN,NE 68509-5046 PHONE:(402)471-2571 FAX:(402)471-2814 Website:linp://www.irc.nc.govi LIQUOR LICENSE INFORMATION NAME OF LICENSED CORPORATION Hong's,Inc.II CLASS&LICENSE NUMBER Z - ( 5L35 TRADE NAME China Buffet STREET ADDRESS 3605 North 147th Street CITY Omaha 141 (i) ,,ecoof SIGNATURE OF CORPORATION PRESIDENT/CEO APPLICANT INFORMATION(MUST BE 21;OR OVER AND NEBRASKA RESIDENT) . NAME Hong Zheng ADDRESS 641 South 38th Street CITY Omaha STATE Nebraska ZIP CODE 68105 HOME PHONE NUMBER(402)344-2251 BUSINESS PHONE NUMBER(402)498-3868 SEX El MALE 0 FEMALE SOCIAL SECURITY NUMBER_ / �n DATE OF BIRTH; PLACE OF BIRTH 64 /1_47 DRIVERS LICENSE NUMBER&STATE eekit4-4 ,SPOUSES INFORMATION(IF NOT MARRIED INDICATE) . SPOUSE NAME Not Applicable SOCIAL SECURITY NUMBER DATE OF BIRTH DRIVERS LICENSE NUMBER&STATE FORM 35-4013 REV.4/05 Logsdon R.L. (Dick)Coyne Commissioner Chairman Commissioner An Equal Opportunity/Affirmative Action Employer Printed with soy ink on recycled paper • cancellation if the information. contained herein is incomplete,inaccurate,or fraudulent. 1 b./' Signature of Applicant Signature of Spouse 511 Subscribed in my presence and sworn to before me this Subscribed in my presence and sworn to before me this day of April 2007 . day of /--/ . A7/' Notary Signature&Seal Notary Signature&Seal ENERAL NOTARY-State of Nebraska ii 11, KAREN K. FISHER A. My Comm.Exp.Jan.21,2010 FORM 35-4013 REV.4/05 — t. 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 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. OYES ElNO If yes, please explain below or attach a separate page. 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 EINO 3. Have you or your spouse ever made a compromise settlement for violation of such laws? OYES ONO 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) OYES ONO 5. Have you filed fingerprint cards and PROPER FEES(if check,make out to the NE State Patrol),with this application? OYES ONO RESIDENCES FOR THE PAST 10.YEARS,APPLICANT AND SPOUSE MUST COMPLETE APPLICANT:CITY&STATE YEAR SPOUSE:CITY&STATE YEAR FROM TO FROM TO Kansas City, Kansas 1996 2000 Omaha, Nebraska Current ' .. EMPLOYERS-LIST LAST TWO EMPLOYERS - - . • MONTH/YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER FROM TO 07/00 03/07 China Buffet Not Applicable FORM 35-4013 REV.4/05 Notary Signature&Seal Notary Signature&Seal ENERAL NOTARY-State of Nebraska ii 11, KAREN K. FISHER A. My Comm.Exp.Jan.21,2010 FORM 35-4013 REV.4/05 PERSONAL OATH AND CONSENT OF INVESTIGATION MUST BE SIGNED BY APPLICANT & SPOUSE 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 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. • il'KO Signature of Applicant Signature of Spouse Subscribed in my presence and sworn to before me this . 'M Subscribed in my presence and sworn to before me this day of April 2007 day of AV/Xt.e...,.t) X".../�� .�- Notary Signature&Seal Notary Signature&Seal „,,, GENERAL NOTARY-State of Nebraska i K;AR,EN K. FISHER My Corm.Exp.Jan.21,2010 • FORM 35-4013 REV.4/05 .21,2010 FORM 35-4013 REV.4/05 rx '-' x z ,� � P CD C4 ( o v4 (ICI Ui Cr7 " N r •-' o d C N to r. N i. o C • � a '0 (, cv CD o rn r' 0 O n �, o