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RES 2007-0484 - Appoint Gregory Mazzuca manager of Embassy Suites Downtown/Old Market O4,tKE\6 9 TEp q w~' �'' RECEIVED STATE OF NEBRASKA y L %41,,,,.�7;y Dave Heineman G � ,• overnorNEBRASKA LIQUOR CONTROL COMMISSION °'la M• :;.!� 07R 3 Hobert B. Rupe �9Rcr„�.%------ Executive Director 301 Centennial Mall South,5th Floor CITY CLERK P.O.Box 95046 C 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/ March 28, 2007 Omaha City Clerk 1819 Farnam Street LC1 Omaha, NE 68183 • Dear Clerk: • Enclosed is a copy of a manager application for Gregory S. Mazzuca in connection with Howard Street Catering Company Inc dba Embassy Suites Downtown/Old Market, located at 555 S 10th 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 ri 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 CONTROL COMMISSIONS S nature of Applicant • Signature of Spouse t Subscribed in myareset ce and sworn to before me this d Subscribed in my presence and sworn to before me this day of Al 4 rC preset; . day of . ...-n- N Signature&Seal Notary Signature&Seal p7Uil1OTHJ.Wain r. GENERALNOTARY-1101011gaia F\ MyCathl.% Me FORM 35-4013 REV.4/05 AP , , No Sig11atu o-6 C.al GENERAL NOTARY-State of Nebraska— [ fll MARDY J.GARDNER . My Comm.Exo.001-1-i Jo/n Notary Signature&Seal ----...— • t 'I FORM 35-4013 REV.4/05 .........r..:.......Y.{........ v. ..........r....v:.x........4..,,v;.v;;....v.v::::::::n....r.......... ..........v.v.t._v{.:ii}?::n:�:•:::.::::::::::.:.r::.:::::.v:::v:::::n.:....n:..::y?:::..:iv'i::v'-w::at: r.n.xv:nh:.:y.:3::::::.......................{v,.::............:...v:::::::::::.v::N:.w:::::.............,,, ..... v::•::v.{.nn.. ..v::•,.�{:+�:::}w:::::.v:::::::.v\w:::.v:::::::v.. ............�.......... ...........................................::.::::::.::.:::.::.:yi:W:::::v.,.::::::::-::::::x{^:4:L:{:::::..::. YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER FROM TO �-- (0)6, - a45, S4('vfLir' i Mon-�°1�1q� �.PM�Qh LWi� t,...eST- (1oL -3 �1 •,.5 ?3, Sl Z-GI 2-- rSENtOt S'�t :..::...:.:....... .:.::.:..:.:: STATE OF NEBRASKA ) • ) SS COUNTY OF ) The above individual(s),being fast 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 ifthe information contained herein is incomplete and inaccurate. Signature of Applicant Signature of Spouse(if applicable) Subscribed in mypresence and sworn to before me this BQ (P � Subscribed in my presence and sworn�before me this day of a►2Ct ay B day of • �c Notary Si nature&Seal Notary Signature&Seal GatERe t.AWRY-Rit3 of Netx a a. STEPHEN D. FORM 35 4013 Phi COMM.NI REV.2/01 PAGE 2 RECEIVED MAR 2 6 2007 APPLICATION FOR LIQUOR LICENSE NEBRASKA LIQUOR EcErt •: CORPORATION MANAGER-FORM 3b CONTROL COMMISSION *MUST BE A NEBRASKA RESIDENT* 301 CENTENNIAL MALL SOUTH 1.lriis G i; �u;/' PO BOX 95046 LINCOLN,NE 68509.5046 PHONE:(402)471-2571 �� ���� LIQUOR FAX:(402)471-2814 c Wcbsitc:http://www.lcc.nc.cov/ IV' LIQUOR LICENSE INFORMATION NAME OF LICENSED CORPORATION !-I f.+LJ AP.� S'12�,�C�" ��T�1l 4J L(`• CLASS&LICENSE NUMBER T �to(06. TRADE NAME T S STREET ADDRESS S�5 SNrim l Da' -STIPI CITY ®W1, A • Jahr1 Q. I �vt�tiw-r� Pres c ter, ,>t40 ► -�- SIGNATURE OF CORPORAT 0 PRESIDENT/C O • APPLICANT INFORMATION(MUST BE 21 OR OVER AND NEBRASKA RESIDENT) NAME &co�,cry S . k47.-7-11C'Gc_ ADDRESS tm 4- S . f I5' CITY CM ahoy-- STATE A.LF ZIP CODE .eft"/a HOME PHONE NUMBER 0-2 f'/P b yZ BUSINESS PHONE NUMBER +40Z •3 I SEX pIALE❑FEMALE SOCIAL SECURITY NUMBER_ DATE OF BIRTH_, _ _. _ PLACE OF BIRTH 7)in a h i DRIVERS LICENSE NUMBER&STATE_ to-E- SPOUSES INFORMATION(IF NOT MARRIED INDICATE) SPOUSE NAME /J� SOCIAL SECURITY NUMBER DATE OF BIRTH DRIVERS LICENSE NUMBER&STATE 14- 111 11111111111 0700005804 FORM 35-4013 REV.4/05 t Subscribed in myareset ce and sworn to before me this d Subscribed in my presence and sworn to before me this day of Al 4 rC preset; . day of . ...-n- N Signature&Seal Notary Signature&Seal p7Uil1OTHJ.Wain r. GENERALNOTARY-1101011gaia F\ MyCathl.% Me FORM 35-4013 REV.4/05 AP , , No Sig11atu o-6 C.al GENERAL NOTARY-State of Nebraska— [ fll MARDY J.GARDNER . My Comm.Exo.001-1-i Jo/n Notary Signature&Seal ----...— • t 'I FORM 35-4013 REV.4/05 .........r..:.......Y.{........ v. ..........r....v:.x........4..,,v;.v;;....v.v::::::::n....r.......... ..........v.v.t._v{.:ii}?::n:�:•:::.::::::::::.:.r::.:::::.v:::v:::::n.:....n:..::y?:::..:iv'i::v'-w::at: r.n.xv:nh:.:y.:3::::::.......................{v,.::............:...v:::::::::::.v::N:.w:::::.............,,, ..... v::•::v.{.nn.. ..v::•,.�{:+�:::}w:::::.v:::::::.v\w:::.v:::::::v.. ............�.......... ...........................................::.::::::.::.:::.::.:yi:W:::::v.,.::::::::-::::::x{^:4:L:{:::::..::. YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER FROM TO �-- (0)6, - a45, S4('vfLir' i Mon-�°1�1q� �.PM�Qh LWi� t,...eST- (1oL -3 �1 •,.5 ?3, Sl Z-GI 2-- rSENtOt S'�t :..::...:.:....... .:.::.:..:.:: STATE OF NEBRASKA ) • ) SS COUNTY OF ) The above individual(s),being fast 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 ifthe information contained herein is incomplete and inaccurate. Signature of Applicant Signature of Spouse(if applicable) Subscribed in mypresence and sworn to before me this BQ (P � Subscribed in my presence and sworn�before me this day of a►2Ct ay B day of • �c Notary Si nature&Seal Notary Signature&Seal GatERe t.AWRY-Rit3 of Netx a a. STEPHEN D. FORM 35 4013 Phi COMM.NI REV.2/01 PAGE 2 LiAR 2 8 2OC i 1. READ CAREFULLY. ANSWER COMPLETELY AND ACCURATELY. :16 Has anyone who is a party to this application,or their spouse,EVER been convicted of or plead guilty to an►ih.4d.1 ;_7: r a�OgqyRy�� charge alleging a felony,misdemeanor,violation of a federal or state law;a violation of a local law,ordin . ~'� M� 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 ap lication. If more than one party,please list charges by each individual's name. OYESi0 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. EYES ONO 3. Have you or your spouse ever made a compromise settlement for violation of such laws? DYES NNO 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 ©NO 5. Have you filed fingerprint cards and PROPER FEES(if check,make out to the NE State Patrol),with this application? fiVES f RESIDENCES FOR THE PAST 10 YEARS,APPLICANT AND SPOUSE MUST COMPLETE APPLICANT:CITY&STATE YEAR SPOUSE:CITY&STATE YEAR FROM TO FROM TO , ?IctSnc, llr. a6 a1 1-k&A<soo.t}e; his 1)1 O 1 03 EMPLOYERS-LIST LAST TWO EMPLOYERS MONTH/YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER FROM TO I t to s Yv►c r i o+-I- Feet•r,,.,-t- Ana 1 T.iC6r,'! l•Orv« 110z -391 . 9aoo 11D5' ) l04— Te>h11Q kk-CJ,RyrM is � `. 1Y Macel y '-Ic'? • 3 41, -gcte FORM 35-4013 REV.4/05 r. GENERALNOTARY-1101011gaia F\ MyCathl.% Me FORM 35-4013 REV.4/05 AP , , No Sig11atu o-6 C.al GENERAL NOTARY-State of Nebraska— [ fll MARDY J.GARDNER . My Comm.Exo.001-1-i Jo/n Notary Signature&Seal ----...— • t 'I FORM 35-4013 REV.4/05 .........r..:.......Y.{........ v. ..........r....v:.x........4..,,v;.v;;....v.v::::::::n....r.......... ..........v.v.t._v{.:ii}?::n:�:•:::.::::::::::.:.r::.:::::.v:::v:::::n.:....n:..::y?:::..:iv'i::v'-w::at: r.n.xv:nh:.:y.:3::::::.......................{v,.::............:...v:::::::::::.v::N:.w:::::.............,,, ..... v::•::v.{.nn.. ..v::•,.�{:+�:::}w:::::.v:::::::.v\w:::.v:::::::v.. ............�.......... ...........................................::.::::::.::.:::.::.:yi:W:::::v.,.::::::::-::::::x{^:4:L:{:::::..::. YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER FROM TO �-- (0)6, - a45, S4('vfLir' i Mon-�°1�1q� �.PM�Qh LWi� t,...eST- (1oL -3 �1 •,.5 ?3, Sl Z-GI 2-- rSENtOt S'�t :..::...:.:....... .:.::.:..:.:: STATE OF NEBRASKA ) • ) SS COUNTY OF ) The above individual(s),being fast 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 ifthe information contained herein is incomplete and inaccurate. Signature of Applicant Signature of Spouse(if applicable) Subscribed in mypresence and sworn to before me this BQ (P � Subscribed in my presence and sworn�before me this day of a►2Ct ay B day of • �c Notary Si nature&Seal Notary Signature&Seal GatERe t.AWRY-Rit3 of Netx a a. STEPHEN D. FORM 35 4013 Phi COMM.NI REV.2/01 PAGE 2 1 • 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. S tore of Applica Signature of Spouse Subscribed i my presence and sworn to before m this 1 Subscribed in my presence and sworn to before me this day of -7 day of P Notary Signature&S Notary Signature&Seal �' I' ' •State d a Ntlbrasta SSA R.MNQ�ERY `, My Comm.Exp.May 2,2010 ilm. RECEIVED MAR 2 8 2007 NEBRASKA LIQUOR CONTROL COMMISSION • (,lick G [u-/ CONTROL L COIViiiit•S.sr :p �ii�1��0 V ' FORM 35-4013 REV.4/05 ll MARDY J.GARDNER . My Comm.Exo.001-1-i Jo/n Notary Signature&Seal ----...— • t 'I FORM 35-4013 REV.4/05 .........r..:.......Y.{........ v. ..........r....v:.x........4..,,v;.v;;....v.v::::::::n....r.......... ..........v.v.t._v{.:ii}?::n:�:•:::.::::::::::.:.r::.:::::.v:::v:::::n.:....n:..::y?:::..:iv'i::v'-w::at: r.n.xv:nh:.:y.:3::::::.......................{v,.::............:...v:::::::::::.v::N:.w:::::.............,,, ..... v::•::v.{.nn.. ..v::•,.�{:+�:::}w:::::.v:::::::.v\w:::.v:::::::v.. ............�.......... ...........................................::.::::::.::.:::.::.:yi:W:::::v.,.::::::::-::::::x{^:4:L:{:::::..::. YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER FROM TO �-- (0)6, - a45, S4('vfLir' i Mon-�°1�1q� �.PM�Qh LWi� t,...eST- (1oL -3 �1 •,.5 ?3, Sl Z-GI 2-- rSENtOt S'�t :..::...:.:....... .:.::.:..:.:: STATE OF NEBRASKA ) • ) SS COUNTY OF ) The above individual(s),being fast 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 ifthe information contained herein is incomplete and inaccurate. Signature of Applicant Signature of Spouse(if applicable) Subscribed in mypresence and sworn to before me this BQ (P � Subscribed in my presence and sworn�before me this day of a►2Ct ay B day of • �c Notary Si nature&Seal Notary Signature&Seal GatERe t.AWRY-Rit3 of Netx a a. STEPHEN D. FORM 35 4013 Phi COMM.NI REV.2/01 PAGE 2 r zZP k ƒ @ .- -' Z 7 q Cl) J / 3 - CEO JP. CD C o E q \ ? ` Q ' 0 § . / / @ U U ... 4 § k \ k § § / CS (IQ � p • CrfI Q.„ n o n ¢ 0 2 0_ § C` k q / 7 §` // R » i . C — 3 $ D ƒ , ` / CD °• LA c J 7 [