RES 2022-0341 - Appoint Casi J Einspahr manager of Sakoon the Spa E-MAILED TO NLCC
Tdtisrgr ,
PA
py;. ,'� ; .n$ STATE OF NEBRASKA •
"� s Pete Ricketts NEBRASKA LIQUOR CONTROL COMMISSION
/y ,: Hobert B.Rupe
Ott. ,� Governor p
(, 1' Executive Director
wgkcii Y�g 301 Centennial Mall South
P.O.Box 95046
Lincoln,Nebraska,68509-5046
Phone(402)471-2571
Fax(402)471-2814 or(402)471-2374
TRS USER 800-833-7352(TTY)
Web Address https://www.Icc.nebraska.gov
Today's Date: March 14, 2022
From: Rebecca Roberts (rebecca.roberts@nebraska.gov)
To: Omaha City Clerk
I have attached a copy of a new corporate manager application submitted to the Nebraska
Liquor Control Commission. Please complete the following information below to indicate
your recommendation.
Licensee Name: Sakoon LLC
Trade Name(DBA): Sakoon The Spa
License Number: 1-122974
Manager Name: Einspahr, Casi J
Due Date: April 28, 2022
n APPROVED
NO LOCAL RECOMMENDATION
n DENIED
COMMENTS: (YOU MAY ATTACH MINUTES AND/OR ADDITIONAL NOTES)
*I ' *;/•
/ -z z
•
Clerk's Name: Date: -1 - [9- 2oz C.,
Kim Lowe Bruce :alley Harry Hoch
Commissioner Chat+lan Commissioner
An EqualOppo. unity Employer
MANAGER APPLICATION Office Use /
INSERT - FORM 3c RECEIVED
NEBRASKA LIQUOR CONTROL COMMISSION
301 CENTENNIAL MALL SOUTH MAR 11 2022
PO BOX 95046
LINCOLN,NE 68509-5046
PHONE:(402)471-2571 NEBRASKA LIQUOR
FAX: (402)471-2814 CONTROL COMMISSION
Website: www.lcc.nebraska.gov
FORM MUST BE COMPLETELY FILLED OUT IN ORDER FOR APPLICATION TO BE
PROCESSED
M AGER MUST:
• Complete all sections of the application. Be sure it is signed by a member or corporate officer,
corporate officer or member must be an individual on file with the Liquor Control Commission
jFingerprints are required. See form 147 for further information, read form carefully to avoid delays
in processing,this form MUST be included with your application. ,
4 Provide a copy of one of the following: US birth certificate,naturalization papers or current US
passport(even if you have provided this before)
Be a registered voter in the State of Nebraska, include a copy of voter card or print document from
Secretary of State website with application
Spo e who will not participate in the business, spouse must:
.. • Complete the Spousal Affidavit of Non Participation Insert (must be notarized). The non-
participatingg spouse completes the top half;the manager completes the bottom half. Be sure to
complete both halves of this form.
• Need not answer question#1 of the application
Spouse who will participate in the business,the spouse must: ,
,.[ • Sign the application
• Fingerprints are required. See form 147 for further information,read form carefully to avoid delays
in processing,this form MUST be included with your application.
• Provide a copy of one of the following: birth certificate, naturalization papers or current US passport
(even if you have provided this before)
• Be a registered voter in the state of Nebraska, include a copy of voter card with application
• Spousal Affidavit of Non Participation Insert not required
p
2200003254 01V) Rey JForm uly 2 103 0
Page 1 of 6
MANAGER APPLICATION Office Use
INSERT- FORM 3c
NEBRASKA LIQUOR CONTROL COMMISSION RECEIVED
301 CENTENNIAL MALL SOUTH
PO BOX 95046 MAR 1 1 2022
LINCOLN,NE 68509-5046 .
PHONE:(402)471-2571
FAX:(402)471-2814 NEBRASKA LIQUOR
Website: www.Icc.nebraska.gov CONTROL COMMISSION
MUST BE:
✓ Include copy of US birth certificate,naturalization paper or current US passport
✓ Nebraska resident. Include copy of voter registration card or print out document from Secretary of
State website
✓ Fingerprinted. See form 147 for further information,read form carefully to avoid delays in
processing,this form MUST be included with your application
✓ 21 years of age or older
CarporationlLLC information
Name of Corporation/LLC:Sakoo n LLC
Premise information _
Liquor License Number: I-122974 Class Type
q yp (if new application leave blank)
Premise Trade Name/DBA:Sakoo n The Spa
Premise Street Address:1 •
529 S 203rd St
City: county:Douglas Zip Code:68130
Premise Phone Number:531 —466-8200
Premise Email address:info@sakoonthespa.eom
The individual whose name is listed as a corporate officer or managing member as reported on insert
form 3a or 3b or listed with the Commission. To see authorized officers or members search your license
information here.
SIGNATU REQUIRED BY CORPORATE OFFICER/MANAGING MEMBER
(Faxed signatures are acceptable)
Form 103
Rev July 2018
Page 2 of 6
Manager's information must be completed below PLEASE PRINT CLEARLY
Last Name: E \ f OvY First Name: C Cl I MI: ,)
Home Address"- \\ O ? '�• 2\ Y-h C 1 r
City: (,11� Y)G{ County: (\Y `)>( Zip Code: ,�SL 7 9 its
Home Phone Number: 4 D 2- 1 2 D.. Li 30
Driver's License Number& State:
Social Security Number:
Date Of Birth: Place Of Birth: e CT Yi 61 Is \c n d, N Q,hrrA S&C1
Email address: Cc)\\ 9 QOt) Son:ODy)Irhe,S pa .Co(y)
Are you married?If yes, complete spouse's information(Even if a spousal affidavit has'beeii.subniitted)
TES ❑NO
Spouse's information • -
Spouses Last Name: E 1 Y1 S'PC 1r)Y First Name: \V Y `V•
Social Security Number:
Driver's License Number& State:
Date Of Birth: MN= Place Of Birth: Ft• LO1U r rd U le, F
APPLICANT& SPOUSE MUST:LIST RESIDENCE(S)-.FOR THE PAST TEN(19)YEAAS': .. -
APPLICANT - SPOUSE
YEAR YEAR YEAR YEAR
CITY & STATE CITY & STATE
,.. FROM TO FROM TO
Yt`rl'l CI r NE /02u air*
bnGuk) , NE 20y2 20g
Form 103
Rev July 2018
Page 3 of 6
MANAGER'S LAST TWO EMPLOYERS'
YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE
FROM TO NUMBER
9020 :vy-rt ScaKoov, lrie c;c)o► 11hctri,Vc)c, CJf i- q - .Y10'
2C1‘' 20ZC 1Mcs 1-s1 tr\1c, Uv. \ic;\ Vic, b-! L1--(A7
1. READ CAREFULLY. ANSWER COMPLETELY AND ACCURATELY.
Must be completed by both applicant and spouse, unless spouse has filed an affidavit of non-
participation.
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, include traffic violations. Also list any charges pending at the time of this application. If more than one party,
please list charges by each individual's name. Commission must be notified of any arrests and/or convictions that may
occur after the date of signing this application.
❑ YES NO
If yes, please explain below or attach a separate page.
Date of Where Description
Name of Applicant Conviction Convicted of Disposition
(mm/yyyy) (City& State) Charge
2. Have you or your spouse ever been approved or made application for a liquor license in Nebraska or
any other state?
EYES r( NO`
IF YES, list the name of the premise(s):
3. Do you, as a manager, qualify under Nebraska Liquor Control Act ( 53-131.01) and do you intend to
supervise, in person, the management of the business?
OYES ONO
Fomi 103
Rev July 2018
Page 4 of 6
4. List the alcohol related training and/or experience(when and where)of the person making application.
*NLCC Training-Certificate Issued: Name on Certificate:
Applicant Name Date Name of program(attach copy of course completion
(mm/yyyy) certificate)
*For list of NLCC Certified Training Programs see training
Experience:
Applicant Name/Job Title Date of Name& Location of Business:
Employment:
5. Have you enclosed form 147 regarding fingerprints?
ONO
Form 103
Rev July 2018
Page 5 of 6
•
II
PER ONAL,OAThI AND CONS NT OF 1NY $TIGATION
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, a spousal 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.
Applicant Notification and Record Challenge: Your fingerprints will he used to check the criminal history
records of the FBI. You have the opportunity to complete or challenge the accuracy of the information
contained in FBI identification record. The procedures for obtaining a change, correction, or updating an
FBI ide ratification record are set forth in Title 28, CFR, 16.34.
"`"'"j(" (
S. atur Man ger Applicant Si ur of S ouse
ACKNOWLEDGEMENT
State of Nebraska
County of Tx;1A.S\ckS The foregoing instrument was acknowledged before me this
1 Y 1 ZZ by CitS1 W jdate a;r H:off Pe v�E.iNc.AC NoW bI
g(vpi 71/4./ Affix Seal
Notary Public signature _,
ian with this application is available in other formats for persons with disabilities.
In compliance t the ADA, pp
A ten day advance period is required in writing to produce the alternate format.
Form 103
Rev July 2018
Page 6 of 6
PRIVACY ACT STATEMENT/
SUBMISSION OF FINGERPRINTS / RECEIVED
PAYMENT OF FEES TO NSP-CID
NEBRASKA LIQUOR CONTROL COMMISSION MAR 11 2022
301 CENTENNIAL MALL SOUTH
PO BOX 95046 NEBRASKA LIQUOR
LINCOLN,NE 68509-5046 ., CONTROL COMMISSION
PHONE: (402)471-2571
FAX: (402)471-2814
Website: wwv'.lcc.nebraska.gov
THIS FORM IS REQUIRED TO BE SIGNED BY EACH PERSON BEING FINGERPRINTED:
DIRECTIONS FOR SUBMITTING FINGERPRINTS AND FEE PAYMENTS:
• FAILURE TO FILE FINGERPRINT CARDS AND PAY THE REQUIRED FEE TO THE
NEBRASKA STATE PATROL WILL DELAY THE ISSUANCE OF YOUR LIQUOR LICENSE
• Fee payment of$45.25 per person MUST be made DIRECTLY to the Nebraska State Patrol;
It is recommended to make payment through the NSP PayPort online system at www.ne.gov/go/nsp
Or a check made payable to NSP can be mailed directly to the following address:
***Please indicate on your payment who the payment is for(the name of the person being
fingerprinted) and the payment is for a Liquor License***
The Nebraska State Patrol—CID Division
3800 NW 12th Street
Lincoln, NE 68521
• Fingerprints taken at NSP LIVESCAN locations will be forwarded to NSP—CID
Applicant(s) will not have cards to include with license application.
• Fingerprints taken at local law enforcement offices may be released to the applicants;
Fingerprint cards should be submitted with the application.
Applicant Notification and Record Challenge: Your fingerprints will be used to check the criminal history
records of the FBI. You have the opportunity to complete or challenge the accuracy of the information
contained in the FBI identification record. The procedures for obtaining a change, correction, or updating
a FBI identification record are set forth in Title 28, CFR, 16.34.
****Please Submit this form with your completed application to the Liquor Control Commission****
Trade Name SAK00h The Spa , LAG
Name of Perso ' ted: C CA S 1 J 0 1 n S p g h r
Date of Birth: Last 4 SSN:
Date fingerprints were taken: O 1 ! O s l 2 G 21
Location where fingerprints were taken: 0nil a h a S1"61 h ecl b'o L
How was payment made to NSP?
L�NSP PAYPORT O CASH ❑CHECK SENT TO NSP CK # •
My finger ' ready on file with the commission — fingerprints completed for a previous
applic i n le 2ye rs ago? YES E
S NATURE QUIRED F PERSON BEING FINGERPRINTED
FORM 147
REV AUG 2020
SPOUSAL AFFIDAVIT OF Office Use
RECEIVED
NON PARTICIPATION INSERT
NEBRASKA LIQUOR CONTROL COMMISSION MAR 11 2022
301 CENTENNIAL MALL SOUTH
PO BOX 95046
LINCOLN,NE 68509-5046
PHONE:(402)471-2571 NEBRASKA LIQUOR
FAX:(402)471-2814 CONTROL COMMISSION
Website: www.lcc.nebraska.gov
yI acknowledge that I am the spouse of a liquor license holder. My signature below confirms that I will
not have any interest, directly or indirectly in the operation of the business (§53-125(13)) of the Liquor Control
Act. I will not tend bar, make sales, serve patrons, stock shelves, write checks, sign invoices, represent myself
as the owner or in any way participate in the day to day operations of this business in any capacity. The
penalty guideline for violation of this affidavit is cancellation of the liquor license.
I acknowledge that I am the applicant of the non-participating spouse of the individual signing below. I
understand that my spouse and I are responsible for compliance with the conditions set out above. If, it is
determined that my spouse has violated (§53-125(13))the commission may cancel or revoke the liquor license.
G ��
Sig a r - ARTICIPATING SPOUSE „. ..„.....„
nature r_ ....
of PPLIC T
KOYy D h s � ahv- CGl gl C \ Y`tcya.V1r
Print Name Print Name
Of _,.._,
State of Nebraska,County of \-e, IN\CS State of Nebraska,County of 1�I kx �LCS
The foregoing instrument was acknowledged before me The foregoing instrument was acknowledgedwl before me
this �' Iin CtIi i/ k 222_ (date) this Ng 2 ✓lZ_ (date)
by VL EH n5vahr by CoS\ Fi� ri3poth r
Name.bf person acknowledged Name of person ack owiedged
signing document) (Individual signing document)
(Individualg g g g
i 11_0W--A- t
Not ry Public Signature Nota Public Signature
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.'1�.JVAL:-RdPARG Ala is 41.2 0.4,7 KLL'_ - aT:ii1P34:".-:s'06eXerrt..v:+7.M'al 3rsaKwiaa'ioles,17,493:1
In compliance with the ADA,this spousal affidavit of non participation is available in other formats for persons with disabilities.
A ten day advance period is requested in writing to produce the alternate format.
FORM 116
REV NOV 2016
Page I 1
3/17/22, 10:31 AM Enterprise Mail-LIQUOR LICENSE MANAGERS APPLICATION FOR OMAHA CITY COUNCIL HEARING-SAKOON
Gm ail Carman Johnson (CCIk) <carman.johnson@cityofomaha.org>
LIQUOR LICENSE MANAGER'S APPLICATION FOR OMAHA
CITY COUNCIL HEARING - SAKOON
1 message
Carman Johnson (CCIk) Thu, Mar 17, '2022 at 10:19
<Carman.Johnson@cityofomaha.org> AM
To: Casi <CEINSPAHR@sakoonthespa.com>, INFO@sakoonthespa.com
Bcc: "Elizabeth Butler (CCIk)" <elizabeth.butler@cityofomaha.org>, "Kimberly Hoesing
(CCIk)" <kimberly.pulliam@cityofomaha.org>
Good morning
RE: SAKOON, LLC
The Omaha City Clerk's Office has received your application from the Nebraska Liquor
Control Commission. The Omaha City Council will hold a public hearing on this request
on Tuesday, APRIL 12, 2022. City Council meetings start at 2:00 PM and are located in
the Legislative Chambers in the Omaha/Douglas County Building located at 1819
Farnam Street, Omaha, NE 68183. You or a representative is required to attend the
meeting.
I ALSO NEED THE DATE OF BIRTH FOR CASI J EINSPAHR. PLEASE SEND ME
THIS INFORMATION AS SOON AS POSSIBLE.
Please notify me if you have any questions.
Thanks
Carman Johnson
Liquor Clerk
City of Omaha/City Clerk
1819 Farnam Street
Suite LC-1
Omaha, NE 68183
402-444-5324
402-444-5263 fax
Carman.johnson@cityofomaha.org
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