RES 2007-0189 - Appoint Jennifer Shallenberge manager of Olive Garden Italian Restaurant #1586 •_---E`S`A-,A1
ED
l`' STATE OF NEBRASKA
4 „A-, ),( ... ;y' Dave Heineman
J2 p�
hii1j� f Governor N 8* 43
NEBRASKA LIQUOR CONTROL COMMISSION
5t Hobert B. Rupe
Executive Director
C,j Y CLERIC
301 Centennial Mall South,5th Floor
A P.O.Box 95046
M Q H�,, N R S K Lincoln,Nebraska 68509-5046
one(402)471-2571
January 18, 2007 Ph Fax(402)471-2814
TRS USER 800 833-7352(TTY)
web address:http://www.lcc.ne.gov/
City Clerk of Omaha
-1819 Farnam LC1
Omaha, NE 68183
RE: Manager Application Submittal
Dear Sir/Madam:
The corporation GMRI Inc submitted the enclosed Application for
Corporate Manager. The establishment has the following liquor
license(s) Class I #62739. The applicant's name is Jennifer L
Shallenberger.
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) 471-4881 .
Sincerely,
ek0
Jackie B. Matulka
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
4 . • •
,C)
•
APPLICATION FOR LIQUOR LICENSE •
CORPORATION MANAGER-FORM 3b tagilogiVi
10i ;lc": %WAKEN
*MUST BE A NEBRASKA RESIDENT*
/MI I
301 CENTENNIAL MALL SOUTH
PO BOX 95046
LINCOLN,NE 68509-5046
PHONE(402)471-2571
FAX:(402)471-2814
Website:http://www.lcc.nezov/
1470014101117.WWWIONiallE 4r" Milltit
NAME OF LICENSED CORPORATION GM RI. Inc. • c.:\I\N!
CLASS&LICENSE NUMBER 62739 •
TRADE NAME The Olive Garden Italian Restaurant#1586
STREET ADDRESS 16929 Lakeside Hills Plaza CITY Omaha
Laurie B. Burns,President
#041•MAVIOn0000,10111):00.0011fSAPTI siViOlklktrAMSPEVIWC :fg;:'!
tg.tdraNi. ,,,NYI~frOALWIA3t41 (1,,,ATter0:7*W1,078Ttlifib)te "71
NAME Jennifer L.Shallenberger
ADDRESS 6420 S162 Terrace Circle
CITY Omaha STATE NE ZIP CODE 68135
HOME PHONE NUMBER (402)934-6527 BUSINESS PHONE NUMBER(402)333-4002
SEX U MALE FEMALE SOCIAL SECURITY NUMBERr
DATE OF BIRTH ' PLACE OF BIRTH Omaha, NE
DRIVERS LICENSE NUMBER&STATE )Nebraska
ritP! ! tOriSfilMtire:
NSPOUSE NAME Gregory S.Shallenberger
SOCIAL SECURITY NUMBER i DATE OF BIRTH ; 1
DRIVERS LICENSE NUMBER&STATE 1 Nebraska
•
•
•
FORM 35-4013
REV.4/05
Ink on recycled paper
s •
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 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 ONO
If yes,please explain below or attach a separate page.
•
Jennifer: Charge: Minor in Possession of alcohol;Where: Nebraska;Date: 1989; Disposition: Pled no contest and paid fine. .
Gregory:Charge: Minor in Possession of alcohol;Where: Missouri;Date: 1989; Disposition: Pled no contest and paid fine. .
N2. 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 FIND
V 3. Have you or your spouse ever made a compromise settlement for violation of such laws?
EYES ENO
4. Do you,as a manager,have all the qualifications required by any person entitled to hold a Nebraska Liquor License?
�l Nebraska Liquor Control Act(§53-131.01)
EYES ENO
N5. Have you filed fingerprint cards and PROPER FEES(if check,make out to the NE State Patrol),with this application?
ENO NO pJ '"W�c' .e.Le,i X . .
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 2002 Present Omaha, NE 2002 Present
Cottage Crove, MN 1998 2002 Cottage Grove, MN 1998 2002
Minneapolis, MN 1995 1998 Minneapolis, MN 1995 1998
EMPLOYERS-LIST LAST.TWO EMPLOYERS '
MONTH/YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER
\�J, FROM TO
03192 Present GMRI,Inc.assigned to Olive Garden#1586,Omaha,NE Sue Ellen Landauer (407)245-4959
08191 03/92 Romeos Mexican Food & Pizza Rodney Evans (402)330-4160
• i
FORM 35-4013
REV.4/05
i •
1
PERSONAL OATH AND CONSENT OF INVESTIGATION JAN 1007
MUST BE SIGNED BY APPLICANT & SPOUSE
NEIRASKA LIQUOR
The above individual(s),being first duly sworn upon oath,deposes and states that the undersigned is the applicant coNraoLAMMISPitiabovc and
foregoing application,that said application has been read and that the contents thereof and all statements contained therein arc 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.
•
•
\\N
Sig attire of Applicant Signature of Spouse
Jenn fer L.Sheila be ger regory S.Shallenberger
Subscribed in my prilince an sworn to before me this Subscribe in my presence and sworn to before me this S
day of S "C day of
t Notary Signature&Seal • Notary Signature&Seal
GENERAL NOTARY-State of Nebraska •
WANDALON L.ROSE
GENERAL NOTARY•State of Nebraska
My Comm.Exp.July 31,2010 WANDALON L.ROSE
lr1i. bly Comm.EXP.Jury 3.,2U411)
•
•
FORM 35-4013
REV.4/05
Sue Ellen Landauer (407)245-4959
08191 03/92 Romeos Mexican Food & Pizza Rodney Evans (402)330-4160
• i
FORM 35-4013
REV.4/05
.,
NEBRASKA LIQUOR CONTROL COMMISSION
.Ei• 6/11RT _ AFFIDAVIT OF NON PARTICIPATION
,17(r , #6 Q.7 3 ' `- Ill tr. 079001,
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. The undersigned individual will
also be waived of filing fingerprint cards,however,will be required to disclose any
violation(s)on all applications and sign all necessary documents.
' \\\'N/ ‘::::' ' 1
Signature o ouse Asking to be Waived
SUBSCRIBED in my presence and sworn to before me this I ) day
of 3 VL 1.)o r ; 4ro`�!
1 e NANCY UNDZY
Om MY CO M.1 MON EXPIRES
"" & ster 20,2007
Signature (Notary
The applying individual,whose spouse is requesting to be waived,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.
it (A �Q.rn; rS±L______1uleydaerer
*Sign of applying indi ' Print name of applying individual
(spouse of individual listed a ove
SUBSCRIBED in my presence and s to before me this i a 1 k _day
of 7G ,..?o u-1 .
('`'-_-. -----:t: ::;:-------.'"--- ------.:-.--•----.- --"-------------.' C----'
Signature of Notary Public
*spouse of individual listed above is the individual required to sign bottom portion of affidavit
FORM 35.4178
GENERAL SDTARY••Slats Of N�ebtask REv gm
CHAD SCHMIDT
MY Unit .JL 1 27,2010 j
l 'd 889 'ON 98c N3O JV8 3AI1O WdtiS:8 L00Z 'S l 'NV1
•
FORM 35-4013
REV.4/05
Sue Ellen Landauer (407)245-4959
08191 03/92 Romeos Mexican Food & Pizza Rodney Evans (402)330-4160
• i
FORM 35-4013
REV.4/05
0" oCD ro _ '
n nCRo 0 CD
rna � �' �
O CIC 0 0 9
v� "
i ,_.
IV \
2
r.o O r
CD
O N cn
cn