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RES 2006-0318 - Appoint Rose Cannon manager of American Legion C Williamson 30 `sTeT,`��, f . O'4 � STATE OF NEBRASKA Dave Heineman • NEBRASKA LIQUOR CONTROL COMMISSION " �:,i s 4,.- ''` Governor "06 MAR Ail 8: Hobert B. Rupe t,w'Rca i^�B6^a' ` Executive Director • 301 Centennial Mall South,5th Floor CITY L. =t\l9 P.O.Box 95046 O A HA, N E I:}?!6 1 , Lincoln,Nebraska 68509-5046 Phone(402)471-2571 • Fax(402)471-2814 TRS USER 800 833.7352(TTY) web address:http://www.lcc.ne.gov/ March 2, 2006 Omaha City Clerk • 1819 Farnam LC1 Omaha NE 68183 Re: American Legion Post 30 Dear Clerk: • Enclosed is a copy of a manager application for Rose Cannon in connection with the American Legion C Williamson 30, located at 1817 N 33rd Street, Omaha, liquor license#C-01253. 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 (rb) t, (balGatLj Holly Erickson Licensing Division encl. cc: file Rhonda R. Flower Bob Logsdon R.L. (Dick)Coyne Commissioner Chairman Commissioner An Equal Opportunity/Affirmatiue Action Employer Printed with soy ink on recycled paper . . RcivEU APPLICATION FOR LIQUOR LICENSE CORPORATION MANAGER-FORM 3b F F 3 2 8 ZOOS *MUST BE A NEBRASKA RESIDENT* Pi 301 CENTENNIAL MALL SOUTH i toL; '�� PO BOX 95046 `�+4''"a�RQ��*O .:>:.' IN sev� � ,1 LINCOLN,NE 68509-5046 PHONE:(402)471-2571 FAX:(402)471-2814 Website:http://www.lcc.ne.gov/ ......�.O w.nw«.e„�-;��NUR.�V. .;�l.;�s1•. ?ed,,, i. r �ii`»'.`::.`'a,..�5i'�"e.`I?�Fw;`�" .�rx� . ,"Yr'- .�.�`s�8 ValrA NAME OF LICENSED CORPORATION a iv) i:e h �C /�D h Pos 1#"3 a. CLASS&LICENSE NUMBER� Oa 55-r O/o2S,3 ) 1 Qwr TRADE NAME . III J 1L9icsr C W \\wnin C J D STREET ADDRESS /81') 27, 33 a Sit" e e 7 CITY 0/n e h �� a SIGNATURE OF CORPORATION PRESIDENT/CEO APPLICANT INFORMATION(MUST BE 21 OR OVER AND NEBRASKA RESIDENT) NAME �DS Ca04d ADDRESS 6 3 d V �. 4"ly ' �y�/ — CITY fY! R G1 Ge- STATE 71 ZIP CODE /o '/Q 1/ •HOME PHONE NUMBER "VOA 0,9- 2 g BUSINESS PHONE NUMBER _-5 3 - 9S lv SEX©MALE EI FEMALE SOCIAL SECURITY NUMBER DATE OF BIRTH _ / PLACE OF BIRTH • 7`a/t c,_ DRIVERS LICENSE NUMBER&STATE 1 II 0. 77•e br. SPOUSES INFORMATION(IF NOT MARRIED INDICATE) SPOUSE NAME C ha ti le S gal n b n SOCIAL SECURITY NUMBER . _ . _ _ DATE OF BIRTH _ _/ DRIVERS LICENSE NUMBER&STATE 7I -Ia r, 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 a. rye t•h f tkkis application. If more than one party,please list charges by each individual's name. "• i t maks ZNO �.s }_ M, If yes,please explain below or attach a separate page. t r�B 2 8 2006 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 1NO 3. Have you or your spouse ever made a compromise settlement for violation of such laws? OYES 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) YES 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 i0 YEARS,APPLICANT AND;SPOUSE MUST COMPLETE APPLICANT:CITY&STATE YEAR SPOUSE:CITY&STATE YEAR FROM TO FROM TO -5ao9 /3oydSt 6mcha 21e- We4/ 1490 )toil soZD9Bald S7c- Doidot. Aekway1990 . EMPLOYERS-LIST LAST TWO EMPLOYERS MONTH/YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER FROM TO 0o09,1,/9)3. !Irnerica/r -Ce9/bn 45fASO ,�osf Co eaiideit you -153 -is66 , grj FORM 35-4013 REV.4/05 ail � � • FF3 Z 8 Z0O5 PERSONAL OATH AND CONSENT OF INVESTIGATION !'. d �& I,C# . s 1 =1 .A MUST BE SIGNED BY APPLICANT& SPOUSE •�N-TR® a:�0'1d_.1.....-- 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. $ � (1 Signature of Applicant Signature of pause Subscribed in m pr sence and swo to before me this ca2�nI Subscribed in m presence and swcyn to before me this.� day of P1 DD w day of fog. �.DI'2� Notary ignature&Seal Notary Signature&Seal ekaJZFE1009 IUANIiA MANUEL My Gmm.Exp.May 1 li,2009 FORM 35-4013 REV.4/05 t.r REE RECEIVEIDAPPLICATION FOR LIQUOR LICENSE c � CORPORATION MANAGER-FORM-3b ED r;L;) 2 8 zoos *MUST BE A NEBRASKA RESIDENT* MAR 2 301 CENTENNIAL MALL SOUTH NEB f 6 `��l��� .�, ..Fti.� :1 PO BOX 9sSd6 RggKA�+ n h 1>'�� uNCA6N;-rlss8 soap -- -- _. ..NTROE QUOR -- .. . 30� . .-.. .-- . PHONE:(402)471-2571 M1S.Sf 0/� " . PAX:(402)471-2814 Y- • r�a c?y�j���c�,l.�q Y•`�`,1�~�n�n•� "��nib�I-`tiy`t-`S<1 r'`a�=`L,'�Is''.:'ii:i�,.e,,,Z:i:!r:_.aY% �:P •'�.4.':1-.... .—�L.UI, .��I Cj.�I'�.•�y++ .�.�r+..�r: .r�� i.��5 ;.:.,}w:.�<{•Yi lf:L.`�:..ti-�'.�`••:i\n� ;�.1'14iJf•�.l•� .�.T.: nt.--A.�.. 4.^:1:. .. ..Y:,�'Y.^.s•\'•..:i�f'.wr,.::Alr,�,ti=1J•14" 'Ch:: �`i.Y;.�\l4: ..�~•� �.r c1 i'�el:i.' �-J:Y.: v,•;p�!�ry� •,-Y<'_ ..� .C........:�Y.....��•'S.t.�..... .1::fL'w�tw:.1���,..�e•�/":��5�„i1�,�� !1 Mr'.'.'�. :L W,�: NAME OF LICENSED CORPORATION ,Q.V)e-.^i e h rC+e lb n PA5 f I-30 • CLASS&LICENSE NUMBER/aSS+B.. 11° b/As-a TRADE NAME STREET ADDRESS, /8/ 7, j j I' Si'e e e l CITY O Mc 7 A Q. 7 SI( NATUPJt OF CORPO TION PRESIDENn'ICEO ' APPLICANT IIs(FORMATION(Must BE 2I'OR'OVER AND NEBI2AKA RESIDENT) r NAME_ '.t'os e- C4Nl i1d n ADDRESS, 6,3 d 4' y/. 4' 4'47 Ay CITY � C`. STATE -,�J ZIP CODE to.fjQ /l HOME PHONE NUMBER 5/40a ' V5S, - Oa. ?? BUSINESS PHONE NUMBER _-s3 - 9S 64 SEX 13 MALE Eg FEMALE SOCIAL SECURITY NUMBER __ DATE OF BIRTH — PLACE OF BIRTH • . 07laXc.,_ DRIVERS LICENSE NUMBER&STATE _L j 710, L SPOUSES INFORMATION(IF NOT MARRIED INDICATE) SPOUSE NAME C Aa t Je$' eaa SOCIAL SECURITY NUMIHRR .: _u DATE OF BIRTH_ DRIVERS LICENSE NUMBER&STATE . 7G b r, FORM 11_4Ot3 REV,4/05 T 'd S9TOESSZD�T LL90 xeWtldoO dg� : TO 90 20 1 W 0' ic_ v F .3 2 8 ZOOS NEBRASKA LIQUOR CONTROL COMMISSION AFFIDAVIT OF NON PARTICIPATION 'tee r.� ���``�a? .._ -.�.•.�:- 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. 664-eLeC Signature of Spouse SUBSCRIBED in my presence and sworn to before me this c.21/457 day of / ,o1D06 . 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. Signature of licensee/applicant Print name of licensee/applicant SUBSCRIBED in my presence and sworn to before me this c 2C5-7 day of _ei? ,ADD 6 . C , Signature of Notary Public FORM 35-4178 GENERAL NOTARY-State of Nebraska REV 2/01 1A. JUANITA MANUEL (IIY Comm.Exp.Map 16,2009 q cI' 7 n @ n 0 0 o \ tit— = = 8` — o § cpq IV ± d § § § r ( ? 0 § / f q . o q �� \N. ) ? 1-0 Va. 7 C' a 0ta N q' 8 0 - V � o . ` o § 6 00 ' 7 2217 F ¢ n0• \ k G ' « R IIID n o q ( kX = n E.