RES 2004-0919 - Appoint William M Theisen manager of Famous Dave's Restaurant STATE OF NEBRASKA
RECEIVED
_-4'CKES 719�,�:h, NEBRASKA LIQUOR CONTROL COMMISSION •
-Oil JUL �j 8. i Hobert B. Rupe
4+:' im_—� , L �L l� V 'f Executive Director '
. M 301 Centennial Mall South,5th Floor
d' '�t „ ;16; '> CITY' b)F CLERK I I. P.O.Box 95046
w ` /u Y " r Lincoln,Nebraska 68509-5046
' •' �'`"_ ��'`i' ��t'� NEBRASKA Phone(402)471-2571
j;,' =' Fax(402)471-2814
July 1 , 2004 TRS USER 800 833-7352(TTY)
Mike Johanns web address:http://www.nol.org/home/NLCC/
Governor
City Clerk of Omaha
1819 Farnam LC1
Omaha, NE 68183
RE: Manager Application Submittal
Dear Sir/Madam:
The corporation Barbecue Ventures of Nebraska LLC DBA Famous
Dave's Restaurant has submitted the enclosed Application for Corporate
Manager. Famous Dave's has the following liquor license(s) Class CK
#55160 and is located at 7051 Ames Avenue, Omaha, NE 68104 (Douglas
County). The applicant's name is William M Theisen.
Please present this application to your City/County Council and return
the results of the action taken to our office. If you have any questions or
comments, please give me a call at (402) 471-4881 .
Sincerely,
/
Jackie B. Matulka
Licensing Division
Enclosure
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 Corporate Manager .
*Must Be A Nebraska Resident*
Please submit in Triplicate ::::::%
- Return to: Nebraska Liquor Control Commission,PO Box 95046
ti..... 1.- 1 Pir'Z'77 11 b 4 g•-•,--,301 Centennial Mall So.,Lincoln NE 68509 ''"•-I s.',7-e;,- p---1,1 Ozt pr—D, .F.4,I
• '..a.•-:,.... .f•i• .4271-: ''..• '
Phone:(402)471-2571 Fax: (402)471-2814 Web address:http://www.noLorg/home/NLCC/
-. ... _
::,:.:.,:,,,.: ..:,;,,,.:.,,i:.,:t.,,i..,.:i.iizii.i.5.?„,.;4:&,,,,.,,,,j,,,,:z.,:,..,,,,H.a.z.:•.:::::w::::,.,::::..:,..4t.::i..,:,:&:t:,,,,,:.::i.,,:e;:ft,:zii...m.E. ,..!,:.{:*.v.01-.0.--....-,,::i,.....,.:-••,---.."----..:•—•,...--.-----.--:-,,,,,,,---....,---1.""K...,i......,,JE:i.ssigiell:V......8.32...rakallearan
•
?::,,,tzso...:&:?....::::::::...:::::ti::,,....*.fti4,e,i•Px,,::,...40...,,,,*.q.,:•:**;.x.oxr,,:,:3,f,,oz,A,:,;:*5:vAIN9.4.Nr.,
..,,,,,,,,,....:::,,,,,,,:.;.:.:.:.:.:.::,:......:::::.:.20:.:.0:4:::::.::::::::,..<:—..„....:.:0,,,...,...,::::::::::::,::,::::::,,,,,,,,,......:x::,,,,.•
NAME OF LICENSED CORPORATION :,i-a ta„-;i4,0, TV1..... ..:eLASS&1.40513A NUMI)?R „.....
f,z,:..,-,-.
ii
Barbecue Ventures of Nebraska, L.L.C. CK/55 ONT130, ...:-! ,:„i,c-v
jUN -2 9 Znal ,,,,,,,i-iii.:!&SION
TRADE NAME OF LICENSED PREMISE
Famous Dave's Restaurant .)
NEBRASKA LIQUOf-,
STREET ADDRESS OF LICENSED PREMISE CITY -' ZIP CODE
7051 Ames Avenue OmahaONTROL COMMISCOSUN9V
Douglas 68104
On behalf of the corporation,I designate this individual as corporate manager.
(-Nil,,.:"...,,1\
Signature of Corporate President/CEO: \)(4
Egimmo.,,i,:,,,::::::::::::xm,:mi,:,!:::?.im:,,,,myx).miktimmieutvti , oi• i• : :. , • ..,:, .. , . .., •..„ ,,,:„.,..,,,g.,:,,--Nm3„: ::,,,,:imi,i,:::,,,::::K:,:::::&::::::::::.:::
ww.„.Q.:,:,,E,,,A,::.,..„7.,0,7,,,,,%44.,.%:,:::,,,.„.;„„:„.„.„,„,,,,,,,:„.4,,,,.„..„0,4,,,..„,.„„,.,,,,,. . ...,,,,:. .......,. ...-,..u.,:::....„..,,..-...,.....,:-..,,,A,.„.,..... -„.,..::i,... .::::::::::::::•ai:z;-..:(i2...v:::r,::::vq.,:...gi.i:ig:iz::i:,:::
NAME(LAST,FIRST,MIDDLE,MAIDEN) SEX SOCIAL SECURITY NUMBER DATE OF BIRTH PLACE OF BIRTH
Theisen, William M. F g ,
Clinton, IA
HOME STREET ADDRESS CITY COUNTY STATE ZIP CODE
1302 S. 101st St. , Apt. 402 Omaha Douglas NE 68124
HOME TELEPHONE NUMBER BUSINESS TELEPHONE NUMBER DRIVERS LICENSE NUMBER&STATE
(402) 398-2969 (402) 391-9007 eNebraska
-----,,-------,:.:.:z::-: ::::-:•,:::::;';'::=::;:z.ix,.:::;',-::::::,:w4-::•.....:::•::-..r7:.:-..::—.:f:.;:.:-:::.:;:::: :4:,:,:-..:-.-%....-----45-- :.,:,--- ..5tFitiiiiiiiiii:Eiragiia•tivnw:::::::::1§::::::immmoi:awiiiimi:i:ii:::..mizimigi!'
ginp.a:V•z?i,ftiniMAR:•;:•;.: StPtitISS-1.:SANFORItyrAalpfigfAE.WIDV. - ., .: - -• .;i: •.. : K..• lirAViya•:40gitftwiiitgigiiiiiWi:
.,::::::::::::iii'A:iftEMORM:MgeMi':0444A:::::00:gmftMg:IAMKA.:::',.:VesA• zirWt:W .:.:;::?,:::::q.W.I!':.. PeW.MZ:i7Y: In
FULL NAME(LAST,FIRST,MIDDLE,MAIDEN) SOCIAL SECURITY NUMBER DRIVERS LICENSE NUMBER
Not Married &STATE
DATE OF BIRTH: PLACE OF BIRTH
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 criminal charge. Criminal
charge means any charge alleging a felony or misdemeanor violation of a federal or state law;or 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.
Di Yes 0 No
Sale to minor; Section 53-180 of Nebraska statutes at Famous Dave's
Restaurant; pleaded guilty on June 25, 2001, with affidavit in mitigation.
•
•
•
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.
;OYES ONO Barbecue Ventures of Nebraska, L.L.C. - CK/54126 - Current license
CK/55160 - Current license
Old Market Ventures, L.L.C. - 1/57724 - Current License
Barbecue Ventures of Kansas, L.L.C. - State Liquor Lic. No. 13-001-4930-01;
Unified Government Lic. No. 03980-00001-00702 - current licenses
FORM 35-4013
REV 2101
•
*prilsd on nocycird moor • PAGE I
. .
3. Have you or your spouse ever made a compromise settlement for violation of such laws? , t; ,,.l, , .
DYES ENO ,...-- " 7 . r,.
•
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 ,..
.. .;r tv))s
5. Have you filed fingerprint cards and PROPER FEES(if check,make out to the NE State Patrol),with this application?
DYES ❑NO
. iiR:��� ?lti � M.f:�:'���v�ww'K"to' ::;.;:ivii::::^Iv:i:�:
..-Pn,t-n:n
r `-
•
..:::::ytvnni�n-)Y%}}:•..-. ..,......... .:..f.n-v-v,v:::t:;n}}'•�.•::•r::: -
:::....:....................:n:.�...,.........,::.�:.:•:.;. .,..: ..y. k,.�:r:::n::�,:•-.;::t..v:. ..:nvr..f.,......,,.x: _. •- .^.'c'-.' �-��??^':>::t:� i::
..:...•--�--,..,......,n.:..:a,,,,.,:•.-....ter. .. ...:.......:................:.........-.>. .:..:.::-.1:�};1:,,,.}:*"�^;'«;Y,..-.,,�:�-nf „�.:.::+::.,--,::•::-::n<-Y"',),c"��<�}:�:�:`��.. ..
iEMManiNim
APPLICANT:CITY&STATE YEAR SPOU. ',1 F''1'k41n'F i. ., ::: YEAR
FROM TO %t j
ii$llvsti'140 , i� �i•.. FROM TO
Omaha, Nebraska 1994 2004 , JUN 2 t z004
•
...........:.:1v .:......; . ....... :.. .. ... .... .•,.:a..-Y},.v.:..f v..^..:ti : .. ia�
r t�4 36t
a
� CO COMMISSION
�4
s
}:M_
,t�:••�:•:::v.n:•)v{ ...h - A JS- 1 . Ny :C :1 <:o y- �♦ :: .-om,: c - ) v ;. w..,4..zM3,7v •:•:::}: j:t
:)}}'L^'•Y.?} :)v•: p
.vawfla 4r:'.!,K:m.
„•:::.::
...v:::
< C ( �
. nv: - .Y.:w:o ;,: :.} :«+^k:irY .h < :�:.' �,n ::f v, n"� :.:. -. ,. . , �. }v � ^ w `�? Z:N 4F J4ti .
YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER
FROM TO
Self-employed
--.-.. ...... . ::ter.._::<.,::.::.<.,,:::::::+;......:....,}. :t^: .}van
• }:.'ti3:3.ka::k?�:
v}:+:n<vnv�.:v:::::!v::nv:h.--.......•"�.ri....... •:-....,.... ::�vnv....f:dr:n ., .,..: n.- r,:'�. ♦ -+. })}�v:......... ��C[y :..
.t..,. ,.raon „Y:: .N`gM1�+��1! };s........:..-.:.......:::>::......... :r.£:.s:.}:::,Y.<....r:,:.kkSsR�,anr ...,.- ���'. ..-.-��}.-:r.�AY��,.,<,.,��..,,,:.�:, �n�CPo;•.��C •:. yv•< ::mv
STATE OF NEBRASKA )
) SS
COUNTY OF DOUGLAS )
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 thereat 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 ifthe information contained herein
is incomplete and inaccurate.
j),mt
Signature of Applicant • Signature of Spoon(if applicable)
•Subscribed in my presence and sworn to before me this 1 ~ta" Subscribed in my presence and sworn to before me this
v of ay. 2004 day of
:, GENERAL NOTARY.State of Nebraska
J.GENTRY HATCH f
My Comm Exp.Oct 31,2005 ' ,i Ft
Notary Signature&Seal Notary Signature&Seal
FORM 35-4013
REV.2i01
PAGE 2
i
AMENDED ARTICLES OF ORGANIZATION
LIMITED LIABILITY COMPANY
Submit in Duplicate i IIIIII Illlllllll IIIII IIIII IIIII IIII liii
NE Sec of Siete - CORP
John A. Gale, Secretary of State 1000498927 PgS: 1
BARBECUE VENTURES, L.L.C.
Room 1301 State Capitol, P.O. Box 94608 Filed: 06/15/2004 10:45 AM
Lincoln, NE 68509
(402) 471-4079
http://www.sos.state.ne.us
Name of Limited Liability Company Barbecue Ventures of Nebraska, L.L.C.
Please check the item or items that are being amended and provide the appropriate
information as changed by the amendment:
✓ Name of Limited Liability Company Barbecue Ventures, L.L.C.
R is }
t
Purpose of Limited Liability Company
jtj14 2 9 20D4
Period of duration is CONTROL COtW it- '-'`
Change in stated capital
Change to any other statement in the articles of organization
(attach additional pages if needed)
This change to the articles of organization was made pursuant to an affirmative of vote of
the majority in interest of the members or in such manner as specifically provided in the
articles of organization.
DATED June 14 , 2004 •
William M. Theisen
Signature of Authorized Representative Printed Name of Authorized Representative
FILING FEE: $15.00 plus $5.00 per additional page
Revised 12/19/2000 Neb. Rev. Stat. 21-2628
•
(5 a o
0 , o cr
O ( Gy r0D. N g
h
0 n N g
0 co `N co Cl)
0 N
Cz' rill cr
cr)Der) eer AD
En
nt 0 ,-. o
� -6 ,
�