RES 2007-0049 - Appoint James Love manager of Kiwk Shop #693 _--'�xE•-S TA�yr1r .
`,�`►-� STATE OF NEBRASKA
/�i Y t Dave Heineman
4,w v,�
';"""�` .,,// °= GovernorDECCi �: sl NEBRASKA LIQUOR CONTROL COMMISSION
= Q j L " Hobert B. Rupe
1"IA?Rcii i�a6� r „ Executive Director
A T
L+
({U�" \• 301 Centennial Mall South,5th Floor
1 t �«.L.ii,i
�1Y 1i,{^�j ,• 1,1 1,T{,\ � ^.,r;' " P.O.Box 95046
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/
tPcf3
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 #67244 . 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
ay 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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APPLICATION FOR LIQUOR LICENSE
CORPORATION MANAGER-FORM 3b DEC 5 200S
*MUST BE A NEBRASKA RESIDENT*P �*
301 CENTENN6 IAL MALL SOUTH nn1f,�1�T� �SnLnQ USOr}
LOBO 9504 68509-504G LS� `ROL CO`�`�J '-
O
PHONE:(402)471-2571
FAX:(402)471-2814
Wcbsitc:http://www.Icc.nc.gov/
,LIQUOR LICENSE INFORMATION
NAME OF LICENSED CORPORATION Kwik Shop Inc.
CLASS&LICENSE NUMBER 067244
TRADE NAME Kwik Shop#693
STREET ADDRESS 5306 N 103rd Street Aye:
CITY Omaha
`` e NDRSF1<p�,: ,...
•GENER4 s ;
4 "3 NoTAR, .' t, AcAae(WoKro(ln?res� cle �
SIGNATURE OF ORPO'' TION PRESIDENT` Rt;`Pam.
APPLICANT INFORMATION (MUST BE 21 O ',a ''ff$1EBRASKA RESIDENT)
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 ® MALE 0 FEMALE SOCIAL SECURITY NUMBER__-- _
DATE OF BIRTH I 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.
DRIVERS LICENSE NUMBER&STATE Nebraska /
FORM 35-4013
REV.4/05
Flower Bob Logsdon R.L. (Dick) Coyne
Commissioner Chairman Commissioner
An Equal Opportunity/Affirmative Action Employer
Printed with soy ink on recycled paper
ay 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
R1ECEIIV ' y
i. READ CAREFULLY. ANSWER COMPLETELY AND ACCURATELY. DEC 5 2006
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,ordinanc-i.r, -,�oluti n • t,t nature
of the charge,where the charge occurred and the year and month of the conviction or plea. Also list any d..r.'°•fi • 'i•7! p�f�this
application. If more than one party,please list charges by each individual's name. � U 0 • - • 'l . �r. Ei
YES ENO
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.
YES fNO
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?
YES ONO
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
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� $,.
'( '?^ i M'� 'R G'TE•tOFtDEE , d
PERSONAL OATH AND CONSENT OF INVESTIGATION
MUST BE SIGNED BY APPLICANT& SPOUSE
The above individual(s), being first duly sworn upon oath,deposes and states that the undersigned is the applicant and/or spouse of applicant who makes the above and
foregoing application,that said application has been read and that the contents thereof and all statements contained therein are true. If any false statement is made in any part
of this application,the applicants)shall be deemed guilty of perjury and subject to penalties provided by law. (Sec.§53-131.01)Nebraska Liquor Control Act.
The undersigned applicant hereby consents to an investigation of his/her background including all records of every kind and description including police records,tax records
(State and Federal),and bank or lending institution records,and said applicant and spouse waive any rights or causes of action that said applicant or spouse may have against
the Nebraska Liquor Control Commission and any other individual disclosing or releasing said information to the Nebraska Liquor Control Commission. If spouse has NO
interest directly or indirectly,an affidavit of non participation maybe attached.
The undersigned understand and acknowledge that any license issued,based on the information submitted in this application, is subject to cancellation if the information
contained herein is incomplete,inaccurate,or fraudulent.
/ , i 1
it
1‘ it) A tat k I ,
Signatrr o Applicant James A. Love Si_ of Spouse Holly A. Love
CA-, op --6C
Subscribed in my presence and sworn to before me this ..�(/ Subscribed in my presence and sworn to before me this_
day of Nrit.t.P.e t ha.-t 7.o61f . day day of.4( h 91 2 -
Signc ifir ...
ature&Seal
F IND R,�i 1 A' ":D R.$ sj -4
,
._ - -"_
FORM 35-4013
REV.4/05
5
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� $,.
'( '?^ i M'� 'R G'TE•tOFtDEE , d
NEBRASKA LIQUOR CONTROL COMMISSION RECFPV'''
Kwik Shop #693 AFFIDAVIT OF NON PARTICIPATION
)EC E 200E
The undersigned individual acknowledges that he/she will have no interest, directly or
indirectly, in the operation or profit of the business, as prescribed in §SecW. M
IN
of the Liquor Control Act. Such individual shall not tend bar, make sales, serve patrons,
stock shelves, write checks, sign invoices, represent themselves as owner or in any way
participate in the day to day operations in any capacity. Undersigned will also be waived
of filing fingerprint cards, however, has disclosed any violation(s) on application.
Ir,��
1 �, Holly A. Love
Signatur of pouse
��XJ
SUBSCRIBED in my presence and sworn to before me this day of
• i
w
fix Signature of Notary Public
The license/applicant understands that he/she is responsible for compliance with the
conditions set out above, and that if such terms are violated, the Commission may cancel
or revoke the license.
James A. Love
'Signature of Licensee/Applicant Print Name of Licensee/Applicant
SUBSCRIBED in my presence and sworn to before me this ` day of
,X4 fin- , 2cOG •
LO
;: ,, Ro il,'AcI (i.SELLS Signature of otary Public
,11' Mom4 wigs
/by /1,zOi7
FORM 35-4178
�5a4 REV 2/01
1� 3NEXPIRES
Ma
mg
CA-, op --6C
Subscribed in my presence and sworn to before me this ..�(/ Subscribed in my presence and sworn to before me this_
day of Nrit.t.P.e t ha.-t 7.o61f . day day of.4( h 91 2 -
Signc ifir ...
ature&Seal
F IND R,�i 1 A' ":D R.$ sj -4
,
._ - -"_
FORM 35-4013
REV.4/05
5
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