RES 2006-0935 - Appoint Thomas Gruidel manager of Cubby's Mormon Bridge y_'{xE. T_aT�p
t , STATE OF NEBRASKA
w•54 9 �; Dave Heineman
d "'� �"•r�, NEBRASKA LIQUOR CONTROL COMMISSION
14;?'?-;- :- .•.'a= Governor obert B. Rupe
11' '
1\\, 9R \ `a6''_- it-cutiO Director
301 Ootennial Prpti South;l5th Floor
?- C"? P.OFSox 95046
•L-ncolti,Nebraska 68109-5046
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TRS`LJSER 800 8 -735'2„'(ITY)
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web address; tip;//wlcc.ne.gov/
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July 18, 2006
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Omaha City Clerk r, '
1819 Farnam LC1 r
Omaha NE 68183 -,
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Re: Cubby's Inc • ` r-� 1
cn
Dear Clerk: >, .c-
Enclosed is a copy of a manager application for Thomas Gruidel connection with Cubby's
Mormon Bridge, located at 9220 Mormon Bridge Road, Omaha, liquor license #D-36781.
Please present this application for manager to your City/Village Council or County
Commissioners and send us the results of their action.
Sincerely, ,
NEBRASKA LIQUOR CONTROL COMMISSION
dj/Ildtpolorl ,
Holly Erickson
Licensing Division
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
S •
06—D9-06� .7 :49 RCVD
APPLICATION FOR LIQUOR LICENSE
CORPORATION MANAGER-FORM 3b
*MUST BE A NEBRASKA RESIDENT*
301 CENTENNIAL MALL SOUTH
PO BOX 95046
LINCOLN,NE 68509-5046
PHONE:(402)471-2571
FAX:(402)471-2814
Website:http://www.lcc.ne.gov/
;LIQUOR LICENSE INFORMATION �� J
NAME OF LICENSED CORPORATION Cubby's, Inc.
CLASS&LICENSE NUMBER Class D 36781
TRADE NAME Cubby's Mormon Bridge
STREET ADDRESS 9220 Mormon Bridge Road CITY Omaha
•
SIGNATU OF CORPORATION PRESIDENT/CEO
APPLICANT INFORMATION (MUST BE 21 OR OVER AND NEBRASKA RESIDENT)_
NAME Thomas Gerald Gruidel
ADDRESS 2117 Dana Lane
CITY Papillion STATE NE ZIP CODE 68133
HOME PHONE NUMBER(402)597-9269 BUSINESS PHONE NUMBER(402)453-2468
SEX ® MALE Di FEMALE SOCIAL SECURITY NUMBER 507-92-5632
DATE OF BIRTH November 16, 1960 PLACE OF BIRTH Omaha, NE
DRIVERS LICENSE NUMBER&STATE H12443405 NE
SPOUSES INFORMATION (IF NOT MARRIED INDICATE)
SPOUSE NAME Cheryl Renee Gruidel
SOCIAL SECURITY NUMBER 460-21-1984 DATE OF BIRTH November 19,1957
DRIVERS LICENSE NUMBER& STATE H12428593 NE
FORM 35-4013
REV.4/05
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 DNO
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. Cubby's Wakefield was issued a temporary identification number 699 on May 15,2006.
DYES DNO
3. Have you or your spouse ever made a compromise settlement for violation of such laws?
*YES f 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?
OYESFAN er r,Nti l� {Zo�S Fri-cc/a (� cc/ on 5-1 4 -o(, Ft3 r W ajke Pets/ locc�Tlea
RESIDENCES FOR THE PAST 10 YEARS,APPLICANT AND SPOUSE MUST COMPLETE .
APPLICANT:CITY&STATE YEAR SPOUSE:CITY&STATE YEAR
FROM TO FROM TO
Papillion, NE 10/95 05/06 Papillion, NE 10/95 05/06
• EMPLOYERS-LIST LAST TWO EMPLOYERS . .
MONTH/YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER
FROM TO
12/97 05/06 Cubby's, Inc Phil Morrison (402) 453-2468
11/96 12/97 Oriental Trading Company 402-331-5511
FORM 35-4013
REV.4/05
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.
Signature of Applicant lLik—ILA Signature of Spouse
Subscribed inmy presence and sworn to before me this 1q4� Subscribed in my presence and atom to before me this t—`
day of �'( , �,L*�, 'aCCS.i . day of t a .o
C_Dlso\ckg,-
Notary Signature&Seal Notary Signature&Seal
L GLENDA M. HIRST
`F COMMISSION NUMBER 703355 co GLENDA LiteIRST
COMMISSION NMER 703355
* '" * My Commission Expires * * MyCommission Expires
May 23,2006 ro� p May 23,2006
FORM 35-4013
REV.4/05
•
: "V
E
NEBRASKA LIQUOR CONTROL COMMISSION
AFFIDAVIT OF NON PARTICIPATION JUN 2 9 2QOG
NEBRASKA LIQUOR
CONTROL COMMISSION
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. Undersigned will also be waived
of filing fingerprint cards, however, has disclosed any violation(s) on application.
Avugci
Signature of Spouse
SUBSCRIBED in my presence and sworn to before me this p2, 3 r/ day
of unt , 2006•
GLENDA M.HIRST sk
a +
lcp� COMMISSION NUMBER 703395 �1\S 1 \
` M''Commission Expirts
2 20 ins` May33,, 0 Signature of Notary Public
The licensee/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.
44,-zziAr_L✓ , / h0M4,S Cam. CrutdeL
Signature of licensee/applicant Print name of licensee/applicant
SUBSCRIBED in my presence and sworn to before me this 2 3 rei day
of aC!ft e.
,
.au! GLENDA M. HIRST C3'X. 4 _ •
'` COMMISSION NUMBER 7033ISn Signature of Notar Public
we io My Commission Expires g •
May 23,2009
FORM 35-4178
REV 2/01
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