RES 2007-0048 - Appoint James Love manager of Kiwk Shop #690 f'y Amy J 17 F` �. \ � ,� STATE OF NEBRASKA
W`;�.��.94� �'% Dave Heineman
�. NEBRASKA LIQUOR CONTROL COMMISSION
r�•°` - Air.„ Governor C1• 'T"
...'.. 06 DEC _D JttFl a• 2b Hobert B. Rupe
a,9ecrr,R.a _ Executive Director
• 301 Centennial Mall South,5th Floor
P.O.Box 95046
°{= i O, N F B I: 3;S A Lincoln,Nebraska 68509-5046
Phone(402)471-2571
Fax(402)471-2814
TRS USER 800 833-7352(TTY)
December 5, 2006 web address:http://www.lcc.ne.gov/
Omaha City Clerk
1819 Farnam Street LC1
Omaha, NE 68183
RE: Manager Application Submittal
•
Dear Sir/Madam:
• The corporation Kwik Shop Inc . submitted the enclosed
Application for Corporate Manager. The establishment has the
following liquor license (s) Class D #67242,. The applicant' s name
is James Albert Love.
Please present this application to your City/County Council
and return the results of the action taken to our office. If you
have any questions or comments, please give me a call at (402)
471-2572 .
Sincerely,
Brianne Crooks
Licensing Division
Enclosure
•
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
day of,�V 1/.19r 2 G.
Notary Signatur Seal No Signature&Seal
FORM 35-4013
REV.4 05
leven Mark Polan (214) 861-1281
FORM 35.4013
REV.4/05
AONEmpie
_ r'Y !Iv?
FORM 35.4013
REV.4/05
Ay4 ilp07 I,
FORM 35-4013
REV.4/05
RM 35-4013
REV.4/05
OR VETERANS l GE OR UNIVERSITY
400
- 12 . 2a. ma.(Authorized Signature) (Date)
1
an!. ..__---_--_----_-.-_-•-_-__-___- ............._
-'' -""' i and.,._-itS--_«-_,-,_____—..heirs and assigns,forever,against the awfu: claims of all pe- r whomsoever
r'
z t IN WITNESS WHEREOF We have hereunto set...our...hand.•'t...._...this /.-". -' day of
' ._
Jul.3' _--___._, -._-_-«.......A-D.19. t-_ 1... �..',.::r::<.__''.�•.._:
? ,x f l -- In preserfce of
� l
' tlSTATEOF NEBRASKA, Lss• c
.^'a 1 ,tCotinty of Douglas, j On this . ..','. of July_ •
,• 6 i967
d! t Ij .---- before me,a Notary Public in and for said County, tonally came the above named
��+ 'Pau•1;,Marquez—and_Helen Marquez., husband and wife,
`I70 ifs ,7 � s
.r, __._.._.....____._...�
1.
edit,�t � 'r4u r j tt wh, BF ..personally known to me to be the identic.,: person..5.......whose naive Are
c a" ,�, j �' :affixedto'the above instrument as grantor -.:.I theY......._....._......_......_.._.._.._..
n , :t „ acknowledged said instrument to be.their-voluntai act and deed.
3 t , ',t �'' 1.VITNESS m'y'hand and Nota�}al Seal the date last aforesaid.
t ( /
i h4 r Trl^•iyt ` i Y� v'✓ '' -1 _ ' 1 ..._._.._...._.._ Notary Public. ,
'f i s F.va i"ss.L 3 afoncthe-t,/r-'� day of .;zia-L..:.:�// .__.A D....
' i 5:: r;,'7"ri%"f�` 3.,yf., bi le{IV bostlas'CDUYN_ NEts S� $,.
'( '?^ i M'� 'R G'TE•tOFtDEE , d
1 66r' l
APPLICATION FOR LIQUOR LICENSE tC I `
CORPORATION MANAGER-FORM 3b
*MUST BE A NEBRASKA RESIDENT* D 0 ` 2006
301 CENTENNIAL MALL SOUTH
PO BOX 95046
LINCOLN,NE 68509-5046 NEBRASKA LIQUOR
PHONE:(402)471-25710
',,z;z, rA�1� inm
FAX:(402)471-2814 ��Y4 �m ��
Wcbsitc:http://www.Icc.nc.gov/
LIQUOR LICENSE INFORMATION
NAME OF LICENSED CORPORATION Kwik Shop Inc.
CLASS&LICENSE NUMBER D67242
TRADE NAME Kwik Shop#690
STREET ADDRESS 3428 South 42nd Street CITY Omaha
\o \ is (GENER4e) i
SIGNATURE OF CORP RATION PRESIDig ?,.�� 11W''7 A f4V/111/?e5-146/1-6
��,,nniin tag"•
APPLICANT INFORMATION (MUST B fVVAND NEBRASKA RESIDENT)
y11,2007
NAME James Albert Love
ADDRESS 5186 Hillcrest Drive
CITY Blair STATE NE ZIP CODE 68008
HOME PHONE NUMBER(402)426-5167 BUSINESS PHONE NUMBER(402)871-5426
SEX Di MALE 0 FEMALE SOCIAL SECURITY NUMBER,
DATE OF BIRTE PLACE OF BIRTH Norfolk, Nebraska
DRIVERS LICENSE NUMBER&STATE Nebraska /
;SPOUSES INFORMATION (IF NOT MARRIED INDICATE)
SPOUSE NAME Holly Ann Love
SOCIAL SECURITY NUMBER DATE OF BIRTH F`
DRIVERS LICENSE NUMBER&STATE Nebraska /
FORM 35-4013
REV.4/05
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
day of,�V 1/.19r 2 G.
Notary Signatur Seal No Signature&Seal
FORM 35-4013
REV.4 05
leven Mark Polan (214) 861-1281
FORM 35.4013
REV.4/05
AONEmpie
_ r'Y !Iv?
FORM 35.4013
REV.4/05
Ay4 ilp07 I,
FORM 35-4013
REV.4/05
RM 35-4013
REV.4/05
OR VETERANS l GE OR UNIVERSITY
400
- 12 . 2a. ma.(Authorized Signature) (Date)
1
an!. ..__---_--_----_-.-_-•-_-__-___- ............._
-'' -""' i and.,._-itS--_«-_,-,_____—..heirs and assigns,forever,against the awfu: claims of all pe- r whomsoever
r'
z t IN WITNESS WHEREOF We have hereunto set...our...hand.•'t...._...this /.-". -' day of
' ._
Jul.3' _--___._, -._-_-«.......A-D.19. t-_ 1... �..',.::r::<.__''.�•.._:
? ,x f l -- In preserfce of
� l
' tlSTATEOF NEBRASKA, Lss• c
.^'a 1 ,tCotinty of Douglas, j On this . ..','. of July_ •
,• 6 i967
d! t Ij .---- before me,a Notary Public in and for said County, tonally came the above named
��+ 'Pau•1;,Marquez—and_Helen Marquez., husband and wife,
`I70 ifs ,7 � s
.r, __._.._.....____._...�
1.
edit,�t � 'r4u r j tt wh, BF ..personally known to me to be the identic.,: person..5.......whose naive Are
c a" ,�, j �' :affixedto'the above instrument as grantor -.:.I theY......._....._......_......_.._.._.._..
n , :t „ acknowledged said instrument to be.their-voluntai act and deed.
3 t , ',t �'' 1.VITNESS m'y'hand and Nota�}al Seal the date last aforesaid.
t ( /
i h4 r Trl^•iyt ` i Y� v'✓ '' -1 _ ' 1 ..._._.._...._.._ Notary Public. ,
'f i s F.va i"ss.L 3 afoncthe-t,/r-'� day of .;zia-L..:.:�// .__.A D....
' i 5:: r;,'7"ri%"f�` 3.,yf., bi le{IV bostlas'CDUYN_ NEts S� $,.
'( '?^ i M'� 'R G'TE•tOFtDEE , d
1. 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.
DYES ONO
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 ` NO
•
3. Have you or your spouse ever made a compromise settlement for violation of such laws?
'DYES E NO
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?
YES ❑i NO
RESIDENCES FOR THE PAST 10 YEARS,APPLICANT AND SPOUSE MUST COMPLETE
APPLICANT:CITY&STATE YEAR SPOUSE:CITY&STATE YEAR
FROM TO FROM TO
Omaha, NE 2005 Omaha, NE 2006
Topeka, KS 2005 2005 Haltom City, TX 1994 2006
Haltom City, TX 1994 2005
EMPLOYERS-LIST LAST TWO EMPLOYERS
MONTH/YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER
FROM TO
04/05 Kwik Shop, Inc. Jimmy Lewis (402) 391-1808
01/87 04/05 7-Eleven Mark Polan (214) 861-1281
FORM 35-4013
REV.4/05
REV.4/05
AONEmpie
_ r'Y !Iv?
FORM 35.4013
REV.4/05
Ay4 ilp07 I,
FORM 35-4013
REV.4/05
RM 35-4013
REV.4/05
OR VETERANS l GE OR UNIVERSITY
400
- 12 . 2a. ma.(Authorized Signature) (Date)
1
an!. ..__---_--_----_-.-_-•-_-__-___- ............._
-'' -""' i and.,._-itS--_«-_,-,_____—..heirs and assigns,forever,against the awfu: claims of all pe- r whomsoever
r'
z t IN WITNESS WHEREOF We have hereunto set...our...hand.•'t...._...this /.-". -' day of
' ._
Jul.3' _--___._, -._-_-«.......A-D.19. t-_ 1... �..',.::r::<.__''.�•.._:
? ,x f l -- In preserfce of
� l
' tlSTATEOF NEBRASKA, Lss• c
.^'a 1 ,tCotinty of Douglas, j On this . ..','. of July_ •
,• 6 i967
d! t Ij .---- before me,a Notary Public in and for said County, tonally came the above named
��+ 'Pau•1;,Marquez—and_Helen Marquez., husband and wife,
`I70 ifs ,7 � s
.r, __._.._.....____._...�
1.
edit,�t � 'r4u r j tt wh, BF ..personally known to me to be the identic.,: person..5.......whose naive Are
c a" ,�, j �' :affixedto'the above instrument as grantor -.:.I theY......._....._......_......_.._.._.._..
n , :t „ acknowledged said instrument to be.their-voluntai act and deed.
3 t , ',t �'' 1.VITNESS m'y'hand and Nota�}al Seal the date last aforesaid.
t ( /
i h4 r Trl^•iyt ` i Y� v'✓ '' -1 _ ' 1 ..._._.._...._.._ Notary Public. ,
'f i s F.va i"ss.L 3 afoncthe-t,/r-'� day of .;zia-L..:.:�// .__.A D....
' i 5:: r;,'7"ri%"f�` 3.,yf., bi le{IV bostlas'CDUYN_ NEts S� $,.
'( '?^ i M'� 'R G'TE•tOFtDEE , d
1VE U
S-.on
PERSONAL OATH AND CONSENT OF INVESTIGATION DEC 5 2OOt
MUST BE SIGNED BY APPLICANT& SPOUSE
f4EBRASKA LIQUOR
am
The above individual(s),being first duly sworn upon oath,deposes and states that the undersigned is the applicantandhatinVofeeterMtuamsstrie above and
foregoing application,that said application has been read and that the contents thereof and all statements contained thereli'An a rue. Tsany 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)NebraskaLiquor 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.
ilkAL I Ate , '
Signature Applicant Signature of Sp
James A. Love olly A. Love
Subscribed in presence a sworn to before me this _5" Subscrib d'n my presence and sv n to before me this 3o
day of -A� 26 a 4, day of )j .-rm/]9r ��-6 .
Notary Sign ure&Seal otary Signature&Seal
elf "` : y �S};oN Ioff ; i�1 . ,...�sioNExping
2007
- - ' .
FORM 35-4013
REV.4/05
Ay4 ilp07 I,
FORM 35-4013
REV.4/05
RM 35-4013
REV.4/05
OR VETERANS l GE OR UNIVERSITY
400
- 12 . 2a. ma.(Authorized Signature) (Date)
1
an!. ..__---_--_----_-.-_-•-_-__-___- ............._
-'' -""' i and.,._-itS--_«-_,-,_____—..heirs and assigns,forever,against the awfu: claims of all pe- r whomsoever
r'
z t IN WITNESS WHEREOF We have hereunto set...our...hand.•'t...._...this /.-". -' day of
' ._
Jul.3' _--___._, -._-_-«.......A-D.19. t-_ 1... �..',.::r::<.__''.�•.._:
? ,x f l -- In preserfce of
� l
' tlSTATEOF NEBRASKA, Lss• c
.^'a 1 ,tCotinty of Douglas, j On this . ..','. of July_ •
,• 6 i967
d! t Ij .---- before me,a Notary Public in and for said County, tonally came the above named
��+ 'Pau•1;,Marquez—and_Helen Marquez., husband and wife,
`I70 ifs ,7 � s
.r, __._.._.....____._...�
1.
edit,�t � 'r4u r j tt wh, BF ..personally known to me to be the identic.,: person..5.......whose naive Are
c a" ,�, j �' :affixedto'the above instrument as grantor -.:.I theY......._....._......_......_.._.._.._..
n , :t „ acknowledged said instrument to be.their-voluntai act and deed.
3 t , ',t �'' 1.VITNESS m'y'hand and Nota�}al Seal the date last aforesaid.
t ( /
i h4 r Trl^•iyt ` i Y� v'✓ '' -1 _ ' 1 ..._._.._...._.._ Notary Public. ,
'f i s F.va i"ss.L 3 afoncthe-t,/r-'� day of .;zia-L..:.:�// .__.A D....
' i 5:: r;,'7"ri%"f�` 3.,yf., bi le{IV bostlas'CDUYN_ NEts S� $,.
'( '?^ i M'� 'R G'TE•tOFtDEE , d
EIVEU
RASKA
Kwik Shop #690 NEB AFFIDAVIT OF NON PART CIPATI4
DEC E Z006
The undersigned individual acknowledges that he/she will have no interest, directly or
indirectly, in the operation or profit of the business, as prescrib` a.s�siti�5(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 fingerprint cards, however, has disclosed any violation(s) on application.
Holly A. Love
Signat re f Spouse
SUBSCRIBED in my presence and sworn to before me this , day of
/VOVe.4.1,&‘__ , 2 .
Signature of Notary Public
The license/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,
James A. Love
Si Lure of Licensee/Applicant Print Name of Licensee/Applicant
SUBSCRIBED in my presence and sworn to before me this day of
)� - Signature of Notary Public
SBIS
TON eons
• • 2007
FORM 35-4178
REV 2/01
tted in this application, is subject to cancellation if the information
contained herein is incomplete,inaccurate,or fraudulent.
ilkAL I Ate , '
Signature Applicant Signature of Sp
James A. Love olly A. Love
Subscribed in presence a sworn to before me this _5" Subscrib d'n my presence and sv n to before me this 3o
day of -A� 26 a 4, day of )j .-rm/]9r ��-6 .
Notary Sign ure&Seal otary Signature&Seal
elf "` : y �S};oN Ioff ; i�1 . ,...�sioNExping
2007
- - ' .
FORM 35-4013
REV.4/05
Ay4 ilp07 I,
FORM 35-4013
REV.4/05
RM 35-4013
REV.4/05
OR VETERANS l GE OR UNIVERSITY
400
- 12 . 2a. ma.(Authorized Signature) (Date)
1
an!. ..__---_--_----_-.-_-•-_-__-___- ............._
-'' -""' i and.,._-itS--_«-_,-,_____—..heirs and assigns,forever,against the awfu: claims of all pe- r whomsoever
r'
z t IN WITNESS WHEREOF We have hereunto set...our...hand.•'t...._...this /.-". -' day of
' ._
Jul.3' _--___._, -._-_-«.......A-D.19. t-_ 1... �..',.::r::<.__''.�•.._:
? ,x f l -- In preserfce of
� l
' tlSTATEOF NEBRASKA, Lss• c
.^'a 1 ,tCotinty of Douglas, j On this . ..','. of July_ •
,• 6 i967
d! t Ij .---- before me,a Notary Public in and for said County, tonally came the above named
��+ 'Pau•1;,Marquez—and_Helen Marquez., husband and wife,
`I70 ifs ,7 � s
.r, __._.._.....____._...�
1.
edit,�t � 'r4u r j tt wh, BF ..personally known to me to be the identic.,: person..5.......whose naive Are
c a" ,�, j �' :affixedto'the above instrument as grantor -.:.I theY......._....._......_......_.._.._.._..
n , :t „ acknowledged said instrument to be.their-voluntai act and deed.
3 t , ',t �'' 1.VITNESS m'y'hand and Nota�}al Seal the date last aforesaid.
t ( /
i h4 r Trl^•iyt ` i Y� v'✓ '' -1 _ ' 1 ..._._.._...._.._ Notary Public. ,
'f i s F.va i"ss.L 3 afoncthe-t,/r-'� day of .;zia-L..:.:�// .__.A D....
' i 5:: r;,'7"ri%"f�` 3.,yf., bi le{IV bostlas'CDUYN_ NEts S� $,.
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STEBAN *VP-
GUILLERMO VAZQUEZ *SECR -ED ROMERO *TREAS -FEDERICO SALAS *2006-SIGNED
CATERING APP-LOUIS VALENCIA*** (OLD-2005-2006-RENEWAL-PRES-ALFRED
MARTINEZ *VP-JOSEPH JUAREZ * SECR-RUPERT AUDRADE*TREAS-FREDERICO
SALAS) *ATTY MIKE KELLEY