RES 2004-0689 - SDL for beer garden at Pauli's June 17-22 2004 EASE TYPE OR PRINT APPLICATION FOR SPECIAL DESIGNATED LICENSE
'F/L1CANT MUST COMPLETE NEBRASKA LIQIOR CONTROL COStMtSSION
.L SECTIONS OF T-rilS FORM P.O.Boz 95046.Lincoln NE 68509
ILL' ISSUED LICENSES ARE MAILED TO LOCAL CLERKS WHERE THE EVENT IS HELD •
All Applications must be received in the Commission Office 10 working days(excluding holidays)prior to the date of the event
Complete and return THE ORIGINAL WITH A DUPLICATE to the Nebraska Liquor Control Commission
A license fee of 540(payable to Nebraska Liquor Control Commission)for each day
LOCAL APPROVAL must be included with this application
A Signed Statement from Local Police Chief or County Sheriff(question 4112)
NON PROFIT CORPORATION MUST include a letter from the IRS declaring that the corporation is exempt from payment of federal
income taxes,or a copy of the corporation's federal income tax return,as filed with the IRS,or a statement(Page))signed by an officer
of the corporation declaring that the copy of the tax return is a true and correct copy as filed with the IRS
Type of Beverage(s)to be served: Beer IS Wine ® Distilled Spirits
Status of the Applicant(check one) • - Public
❑ Municipal 0 Political 0 Fine Arts 0 Fraternal 0 Religious 0 Charitable Retail 0 Service
Corporation Corporation Museum Corporation Corporation • Corporation Licensee Corporation
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Name and Address of Corporation.Organization or Licensee obtaining license. If licensee,give license number
(City,State,County Number,Zip Code) And Class(Example C/K)
AUL-1 5 T OL.0 PfiU1-1 S 5?0 R i 5 5?'R rr ) "Am& -/g L£AVEA1 fir X' �1; O44A1 n, AvE. C c 1 O S"--
Address or location of premises to be covered by license,(City,County Number,Zip Code)
7 0/62 L../A V/)LL)O i TH , �;"✓1� ;L , Dobc&c-r4 S Cock,/Li y 6 `S r o S
Is this PREMISE currently licensed under the Nebraska Liquor Control Act? fa YES 0 NO
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Name and Address of owner or lessee and name of principal occupant of the premises for which the license is requested.
it1L J 6.7tZ(E(70 5i/ jug/- N1'c f- Lu LJ ?,4u/.._r5 5r-oier 5 e .5pfe(�s
Please list the name and telephone number of the primary event supervisor,who will actually be present at the location of the event when
iccurs,rhat can be contacted by law enforcement before and during the event,and who is responsible for ensuring that any applicable laws,
finances,rules and regulations are adhered to. Supervisor must sign on page 2. 0
r� 2./10,,Z • 5-5-1 - / 3 S— °tic c � c c
6 E=C� ). �o� _ a �... - 5•5 e15 62 l E{Cio Z- 37k t -O I t i tit DATE(S)OF EVENT(If a Sunday.attach local Sunday Sales Ordinance and hours of consumption.)
JuNE /`7 — • J4 - 2601 o . /;S-- L
.EASE INDICATE AN ALTERNATE DATE OR LOCATION IN THE EVENT OF BAD WEATHER:
Times)of event(example Sam to lam,this is considered one day)
. FROM: //%oo/4711 TO: /.'no i 4 Sr.r, Sire. 2( 2O0 Il noon -4o Aev‘
Desmibe the Typ of Acrivi to be carried on during the time period for which the license is requested.
7gt N K-5 ii ILL FEsIZ. J�0 _
. Provide an estimated number of attendees at this event 500- i�oa . If the number of attendees is over/250 attach a separate page
licating the steps that will be taken to prevent underage persons access to alcoholic beverages.
. PLEASE ATTACH A SIGNED STATEMENT FROM YOUR LOCAL POLICE CHIEF OR COUNTY SHERIFF,WHICHEVER
APPLICABLE,THAT LOCAL LAW ENFORCEMENT HAS BEEN INFORMED IN ADVANCE OF THIS EVENT,AND IFTHE1
ZE AWARE OF ANY REASON THE EVENT SHOULD NOT OCCUR STATEMENT IS ON FILE IN THE NEBRASKA
TIOTOR CONTR OMTgSTnNtc nFFTCF_
. List the number of SDL's that you have applied for at this specific location in the last six months.
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CONTINUE ON BACK — .
FIRM 354t2t
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NEBRASKA LIQUOR CONTROL COMMISSION -
APPLICATION FOR SPECIAL DESIGNATED LICENSE - -
UNDER NEBRASKA LIQUOR CONTROL ACT
14. 13sciption of the premises: 0 Inside Building g Outdoor Area
Dimeesans of area to be covered by license: x • .PIease draw in the space provided below,the area where• .
Iiquolowill be sold and consumed. LENGTH WIDTH (In feet) .
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If our area,how will premises be separated from areas open to the general public? rg Fenee. lit Tent CI Other(if other,'please exnla. .
15: khe premises to be covered by the license located within the citylvillaee limits?_..._..__-....-......_._.-.—.__.-.'.:.::..•----=--R YES 0 NO '
I fl 1BLe premises to be covered by the license within 150 iyet of any , =.,school,1==C'='1+or home Fort the aged or indigent aerso s ' p
or for eterans,their wives or children?.---_........_..................: .....____.__.._.. .._...._..__..___..._. ...•....:... _:.: . ❑ YES NO
17. Fmlain how alcoholic liquors will be purchased by the licenser-if purchased from a retail licensee,please give the name arid license number_
18. Ithe premises to be covered by the license comply with all Nebraska sanitation laws? .... .._--_ _.:..OYES ❑NO :--
19. A:Lbere separate toilets for both men and women?.._.._..,.___--.._..-. :.. _—.[VES.ONO..
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20. titer information or requests by the applicant .-
21. Mill there be any games of chance operating during the event?BYES ONO . ICE-Iv 0 '
NO;�:E: Only games of chance approved by the DeptTent of Revenue,Charitable Gaming Division are permitted: All other forms:of.. .
gamiig are prohibited by State Lawn There are nopoops for Non Profit Organizations. This is only an application fora Special .
Desisated License under the Liquor Control Act and is not s • .mbling permit application. .
22.I Mare thai I am the authorized representative of the above named license applicant and that the statements made on this application.are tie
to thi�t of my knowledge and belief. I also consent to an investigation of my backgrvrmd including all records of everykind amchmmftag police
reconiVI agree to waive any rights or causes of action against the Nebraska Liquor Control Commission,the Nebraska State Patrol crafty other.
indivi sal releasing said information to the Liquor Control Commission or the Nebraska State PatroL I further declare that the license applied for::..
will rime used by any other person,group,organization or corporation for profit or not for profit and that the event will be supervised by persons
direciiiresponsible to the holder of this Special a— -fed 'c}risee. •
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sign
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here ?lvt.u( - A ' . / ' �7�hl OL3/•\CJ.
thorized Repro •v plicant l/ Title .
here• sign • OLt)A><(� •�
Supervisor . . . Title . / . °
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The Imrequires that no special designated license provided for by this section shall be issued by the Commission without the approval of the local
govermrsag body. For the purposes of this section,the local governing body shall be the city or village within which the particular place for which
the steal designated license is requested is located,or if such place is not within the corporate limits of a city or village,then the local gave .
body�all be the county within which the place for which the medal designated license is requested is located.
In Casaliance with ADA,this form is available in other form for persons with disabilities.
A teary advance period is requested in writing to produce thtI1tetnate format • ' .
STEPS TAKEN TO PREVENT UNDERAGE ACCESS TO ALCOHOLIC BEVERAGES
THERE IS A FENCE THAT IS INSTALLED AROUND THE ENTIRE BAR.
AT EACH ENTRANCE THERE 2 OR 3 EMPLOYEES DEPENDING ON
THE PARTICULAR NIGHT THAT CHECK EVERY PERSONS I.D.. NO
PERSON UNDER THE AGE OF 21 IS ALLOWED TO ENTER. THIS HAS
BEEN OUR POLICY FOR THE PAST,714)YEARS.
WE WILL ALSO HAVE 6 TO 12 OFF DUTY OMAHA POLICE OFFICERS
TO PROVIDE ADDED SECURITY AROUND THE PARKING LOTS EACH
NIGHT.
OUR GOAL IS TO HAVE THE BEST RUN EVENT IN OMAHA DURING THE
CWS. HOPEFULLY OUR RECORD SPEAKS FOR ITSELF.
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