RES 2006-1175 - Appoint Kathleen Jo Kriley manager of Baker's Supermarket #301 •
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STATE OF NEBRASKA
Dave Heineman _
'4 d` `���
j ��� ,* Governor 1. Yt; NEBRASKA LIQUOR CONTROL COMMISSION
yI�• • a ..W
[ Hobert B. Rupe
a, ar„�._„ Executive Director
06 SEP 21 Aa't 8: 54 301 Centennial Mall South,5th Floor
P.O.Box 95046
Lincoln,Nebraska 68509-5046
i. ' ‘ Phone(402)471-2571
. e`�ternber 18, 2006 Fax(402)471-2814
l 11 �� k TRS USER 800 833-7352(TTY)
web address:http://www.nol.org/home/NLCC/
City Clerk of Omaha
1819 Farnam LC 1
Omaha, NE 68183
RE: Manager Application Submittal
Dear Sir/Madam:
The corporation Dillon Companies Inc submitted the enclosed
Application for Corporate Manager. The establishment has the
following liquor license(s) Class C #65523. The applicant's name is
Kathleen Jo Kriley.
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,
61 I; dig 14
�.
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
RECEIVED
APPLICATION FOR LIQUOR LICENSE SEP 12 2006
CORPORATION MANAGER-FORM 3b
*MUST BE A NEBRASKA RESIDENT* NEBRASKA LIQUOR
301 CENTENNIAL MALL SOUTH CONTROL COMMISSION
PO BOX 95046
LINCOLN,NE 68509-5046
PHONE:(402)471-2571
FAX:(402)471-2814
Website:http://w'ww.lcc.ne.auk,/
LIQUOR LICENSE"INFORMATION
NAME OF LICENSED CORPORATION Dillon Companies, Inc.
CLASS&LICENSE NUMBER C 65523
TRADE NAME Baker s Supermarkets •#30
STREET ADDRESS 4405 N. 72nd St. CITY Omaha, NE 68134
SIGNATURE OF CORPORATION PRESIDENT/CEO
APPLICANT INFORMATION (MUST BE 21 OR OVER AND NEBRASKA RESIDENT)
NAME Kathleen Jo Kriley
ADDRESS 7216 S. 71st Avenue
CITY LaVista STATE NE ZIP CODE 68128
HOME PHONE NUMBER (402) 597-6468 BUSINESS PHONE NUMBER (402) 397-4321
SEX 0 MALE Et FEMALE SOCIAL SECURITY NUMBER
DATE OF BIRTH PLACE OF BIRTH Dodge City, KS
DRIVERS LICENSE NUMBER&STATE NE
SPOUSES INFORMATION(IF NOT MARRIED INDICATE)
SPOUSE NAME Single - Not Married
SOCIAL SECURITY NUMBER N/A DATE OF BIRTH N/A
DRIVERS LICENSE NUMBER&STATE N/A
•
FORM 35-4013
REV.4/05
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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.
EYES 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 NO
3. Have you or your spouse ever made a compromise settlement for violation of such laws?
DYES EtIO
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)
EYES ONO
5. Have you filed fingerprint cards and PROPER FEES(if check,make out to the NE State Patrol),with this application?
EYES ONO
RESIDENCES FOR THE PAST 10 YEARS,APPLICAiNT AND SPOUSE MUST COMPLETE
APPLICANT:CITY&STATE YEAR SPOUSE:CITY&STATE YEAR
FROM TO FROM TO
Kathleen Jo Krilev (Not Married)
7216 S. 71st Ave. , LaVista, NE 2001 Present
Applecreek Apts. , Omaha, NE 1999 2001
Lincoln, NE 1996 1999
EMPLOYERS-LISTLAST TWO EMPLOYERS
MONTH/YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER
FROM TO
2001 2006 Dillons Philip Farmer 397-4321
1980 2001 Baker's Bruce Friedlander 670-5103
FORM 35-4013
REV.4/05
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RECEIVED
. SEP 12 2006
PERSONAL OATH AND CONSENT OF INVESTIGATION NEBRASKA LIQUOR
MUST BE SIGNED BY APPLICANT & SPOUSE CONTROL COMMISSION
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.
,__ QIDA` G (Not Married)
cant of Spouse
Signature of App � Signature
Kathleen Jo Kriley •
��JJ
Subscribed in my presence and sworn to before me this /�' Subscribed in my presence and sworn to before me this
day of Augut st, 2006 •
day of
GENERAL NOTARY-State of Nebraska
f
JOAN BOEDER
My Comm.Exp.April 16,2007
(4"/Z2.61 •
Notary Signature&Seal Notary Signature&Seal
•
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FORM 35-4013
REV.4/05
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