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RES 2006-0161 - Appoint Nyla Brotherton manager of Lone Star Steakhouse & Saloon r r r- n STATE OF NEBRASKA -Y n ~ 1ti €�: `; , y,d:•?-�� s; ,.� „ Dave Heineman ! ova,; NEBRASKA LIQUOR CONTROL COMMISSION '' Hobert B. Rupe Governor 06 FEB - • AM 8+ 39 Executive Director CITY €�ti L Rl`,� 301 Centennial Mall South,5th Floor P.O.Box 95046 O M 1 H A. NE Bt R A S(S A 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/ January 30, 2006 Omaha City Clerk 1819 Farnam St 1LC1 Omaha NE 68183 Re: Lone Star Steakhouse & Saloon of Nebraska Inc Dear Clerk: Enclosed is a copy of a manager application for Nyla Brotherton in connection with Lone Star Steakhouse & Saloon, located at 651-657 N 114th St., Omaha, liquor license#I-27069. 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 • 61)1\J Holly Erickso.. 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 • APPLICATION FOR LIQUOR LICENSE `' • • ' CORPORATION MANAGER-FORM 3b 13) *MUST BE A NEBRASKA RESIDENT* JAN 3 0 2036 301 CENTENNIAL MALL SOUTH PO BOX 95046 LINCOLN,NE 68509-5046 ����_ KA LIQUOR PHONE:(402)471-2571 t..1 FAX:(402)471-2814 Website:http://www.ice.ne.govi ovi LIQUOR ,TCEN E 'ORMATION m z s,. y f NAME OF LICENSED CORPORATION Lone Star Steakhouse&Saloon of Nebraska,Inc. CLASS&LICENSE NUMBER Class I License#27069 TRADE NAME Lone Star Steakhouse&Saloon STREET ADDRESS 651-657 N. 114th Street CITY Omaha,NE 68154 LONE STAR STEAKHOUSE & SALOON OF NEBRASKA, INC. • John •D. White, President SIGNAT F C©RP©RATYON:PRESIDENT/CEU A ' IC T N 'ORMN1iON SST B 21,OR OVER AND NEBRASKA RESIDENT), . ' NAME f%1 /rc Klan& i.1 AgD4A l�n ADDRESS IS93O H t'Y4pr AYL • • - CITY DYVI[nnQ STATEIr\ ZIP CODE ( 130 HOME PHONE NUMBER 4027's 2. Z,+-5 BUSINESS PHONE NUMBER 493-1331 SEX 0 MALE Q FEMALE SOCIAL SECURITY NUMBER_ _ DATE OF BIRTH PLACE OF BIRTH TOLt)cd)) QYV1i1J DRIVERS LICENSE NUMBER&STATEkbfraS _ SPOUSES INFORMAT.TON F NOT 'IARR D INDICATE) .. SPOUSE NAME Ket-kAq SCE ?Dr le n SOCIAL SECURITY NUMBER DATE OF BIRTH _ DRIVERS LICENSE NUMBER&STATE KLIOi171��CG _ FORM =4 REV.35 4/00/135 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. YES ONO If yes,please explain below or attach a separate page. y Ia. (,YN ruj red L& 19`d$'C did Qteact 9 Lt1C1) 6" -tp ai`(� 5p 5 £ us �r g,2-- =\Y<y krsura�e ail 02 1 Y cusp 1.y)ck I t + I2.an (..42a.uirt5 19•59. todlr S 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. DYES ONO 3. Have you or your spouse ever made a compromise settlement for violation of such laws? DYES ENO .J use- .aid cur licte. s 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) RYES ONO 5. Have you filed fingerprint cards and PROPER FEES(if check,make out to the NE State Patrol),with this application? RYES ONO RESIDENCES Fo R l ii PAS,1 10 FEARS,APPLICANT AND SPOUSE MUST COMPLETE APPLICANT:CITY&STATE YEAR SPOUSE:CITY&STATE YEAR FROM TO FROM TO ViQf\J COVird Q 1994 1i93 UnUex C'otan"ad o 114 1111 1 So,k\ra�. )((visas t999 Sakvna, Kansas 1 - 19q9 W 1c A-E. Y nsaLs 1999 ?sue W icAA-c. Canscts 1999' Z1S omo,l(b. Y\e.Vx s o., 2a05 cr ni- Onna)ncA. n.da S 2- 'Present EMPLOYERS-'LIST LAST TWO EMPLOYERS MONTH/YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER FROM TO i/99 1/05 P ppWees 5tazin 1)e-c ef'sco 913-s6Y-9a/L 3105 Presevl- toneslar /(- se- SGiawn Oi c/ '7 9/3- 1-9o/Z FORM 35-4013 REV.4/05 RECEIVED JAN 3 0 2066 PERSONAL OATH AND CONSENT OF INVESTIGATION COMS LIQUOR MUST BE SIGNED BY APPLICANT& SPOUSE CONTROL COMMISSIONOR 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. • _ . ignature of Applicant Signature of Spouse Subscribed in my presence and worn to before me this Subscrib in my presence andAwmo to before me this day of 0011(/a/y/Otoo�. day of Subscribes, Li/79/(Aft/a /I" 1 16/L. Notary Signature&Seal Notary Signature eal A GENERAL NOTARY-State of Nebraska GENERAL NOTARY-State of Nebraska Ili ANITA M.KUNKEN ANITA M.KUNKEN t ,t My Comm.Exp.March 17,2009 J� * My Comm.Exp.March 17,2009 FORM 35-4013 REV.4/05 - D RECE1VID.. JAN 3 0 2006 NEBRASKA LIQUOR CONTROL COMMISSION SPOUSAL AFFIDAVIT OF NON PARTICIPATION IN A LIQUOR LICENSE 21 boak\lerAon The spouse, , acknowledges that he or she will have no interest,directly or (frill name of spouse) indirectly, in any part of the daily operations or profit of the business l- v'-.5-\6r 5\cb k.oVS 4,255 M ``' 5 (name,trade name CSAN ct. \e.- (o i o/ as prescribed in Sec. 53-125(13)of the Nebraska Liquor Control Act. &address of business) Such individual shall not tencfbar, stock shelves, write checks, sign invoices, represent themselves as an owner or in any other way participate in any part of the operation of the licensed business. The licensoe/applicant understands that he or 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 f non participating spouse Signs re icensee/applicant • 00.0 aged pow FORM 35-4178 Rev.4/00 d64 /if)? gd/a_ho= 5,ezeat-iy /99/ /993 y- � f ra-e-b:ere- -how Sya /Y7 ,fia194- o)///tf-a Zacit 4s FI JAPi 3 0 2Q06 GONTApL C�OLM�ON £ � . ., gl q G ƒ 0 7 cr Q 9 p — @ q ƒ 0 - e \ m ? A n k ® E q 7 / \ „ r) § ^ 00 _ _ - e 1 § 0 ƒ 5- 0 o n C0hR. O \ @ p ,CD / k C \ q » § C4 / \ tZ ?! -. Cr A §. § $ CD o o §' 2