RES 2022-0524 - Appoint Judith M Alderman manager of Joslyn Castle E-MAILED TO NLCC 5 -2.S— 2
S .,. 9 pF h0
` "- STATE OF NEBRASKA
a
` Pete Ricketts . NEBRASKA LIQUOR CONTROL COMMISSION
iy�,, r' ^ a Governor Hobert B.Rupe
Executive Director
e , 11>e x$61, 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.lcc.nebraska.gov
Today's Date: April 25, 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: Joslyn Castle Trust Inc
Trade Name (DBA): Joslyn Castle •
License Number: 1-103338
Manager Name: Alderman, Judith M =
Due Date: June 09, 2022
APPROVED
NO LOCAL RECOMMENDATION
n DENIED
COMMENTS: (YOU MAY ATTACH MINUTES AND/OR ADDITIONAL NOTES)
Pam— 2 i
Clerk's Name: Date: S—
Z 2077
Kim Lowe Bruce Bailey Harry Hoch
Commissioner Chairman Commissioner
i,Equal Opportunity Employer
MANAGER APPLICATION office use •
INSERT-FORM 3c RECEIVED
NEBRASKA LIQUOR CONTROL COMMISSION APR 2ZOZZ
301 CENTENNIAL MALL SOUTH
PO BOX 95046
LINCOLN.NE 68509-5046 NEBRASKA LIQUOR
PHONE: (402)471-2571 CONTROL COMMISSION
FAX:(402)471-2814
Wcbsitc:www•lcc.nebraska.gov
FORM MUST BE COMPLETELY FILLED OUT IN ORDER FOR APPLICATION TO BE
PROCESSED
MANAGER MUST:
yl4 Complete all sections of the application. Be sure it is signed by a member or corporate officers
corporate officer or member must be an individual on file with the Liquor Control Commission
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.
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)
4 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
Spouse who will not participate in the business, spouse must:
• Complete the Spousal Affidavit of Non Participation Insert (must be notarized). The non-
a'
participating 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
i 11 I I
• 2200005177 Form 103
— Rev July 2018
Page 1 of 6
MANAGER APPLICATION Office Use
INSERT-FORM 3c RECEIVED
NEBRASKA LIQUOR CONTROL COMMISSION
301 CENTENNIAL MALL SOUTH APR 2 5 2022
PO BOX 95046
LINCOLN,NE 68509-5046
FAX: (4 2)471-2 CONTROL COMMISSION
NEBRASKA LIQUOR
FAX:(402)471-2814
Website:www.Icc.nebraska.gov
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
Cotporation/LLC information
Name of Cotporation/LLC: 6 5_1 e.,6/3 / 0,6 / ' !U
Premise information
Liquor License Number: / O . .5 Class Type L.LQ, s j (if new application leave blank)
Premise Trade Name/DBA: r Stcl n (ii/e
Premise Street Address: gO L 0.ve n p t c l .Scree
City: 0 )Yl �-, i County: t 1 5 Zip Code:
Premise Phone Number: 410 W :S / q
Premise Email address:a CLL de r Gi'y1 e , Oj/ i,i fie: i;MI
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.
1,‘t, 064,
SIGNATURE 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
f
Last Name: A G de.(pi )1 First Name: Trikji 11 MI: A
Home Address: / L/C /d o r WI ,3 Z Sire e e t`
City: }'Yl•ak4 E County: ,,1JP( 2.J 5 Zip Code: Log. /d 3 f
Home Phone Number: 2! :�. ]
Driver's License Number& State:
Social Security Number: 1111111111111111111111111111
Date Of Birth: .111111 Place Of Birth:cPvit A v l t tie )U i
Email address: cal d ermbl.n tt.dY g i71GGt' i n't p i L)
Are you married?If yes, complete spouse's information (Even if a spousal-affidavit has been submitted)
❑ YES [ NO
Spouse's information
Spouses Last Name: First Name: - MI:
Social Security Number:
Driver's License Number& State:
Date Of Birth: Place Of Birth:
APPLICANT& SPOUSE MUST LIST RESIDENCE(S)FOR THE PAST TEN (10)YEARS
APPLICANT SPOUSE
CITY & STATE YEAR YEAR CITY & STATE YEAR YEAR
FROM TO FROM _ TO
Form 103
Rev July 2018
Page 3 orb
MANAGER'S LAST TWO EMPLOYERS
YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE
FROM TO NUMBER
rre
(ft7f3 zo/6 fl16+h40 e�. eve7
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.
0 YES i" 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?
DYES [lo
IF YES, list the name of the premise(s):
3, Do you, as a manager, qualify under Nebraska Liquor Control Act( 53-I 31.01.i and do you intend to
supervise, in person, t e management of the business?
EYES r •
Foram 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:(l t3 r 5D JL Name on Certificate: J4iU i 1 /1 /V J. tU e ri1?(,V/
Applicant Name (m>Datyyyy) Name of program(attach copy of course completion
certificate)
_1U/ . li/ / rman o - Pespvns)A/ i iftli e $S rvicia -a>rrl
*For list of NLCC Certified Training Programs see training
Experience:
Applicant Name/Job Title Date of Name&Location of Business:
Employment: n
r/i IJ7 in man F;6r £3 :Tosl y C�aS/-/P
_! IA
PnaLCDe f y
5. Have ou enclosed form 147 regarding fingerprints?
ES ENO
Form 103
Rev July 2018
Page 5 of 6
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PERSONAL OATH AND CONSENT OF INVESTIGATION
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 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 FBI identification record. The procedures for obtaining a change, correction, or updating an
FBI identification record are set forth in Title 28, CFR, 16.34.
Z4-(//71
%`Signature of Manager Applicant Signature of Spouse
• ACKNOWLEDGEMENT
State of Nebraska
County of ugkClS - _ The foregoing instrument was acknowledged before me this
1/P0/20d by J4411 A I ci&rr7Yl
date NAME OF PERSON BEING ACKNOWLEDGED
9/1/104k. 6(177/0_,
Affix Seal
Notary Public signature GENERAL NOTARY-State ofNebraska
ALAINA KOCINA
L My Comm,Exp.January 4,2025
In compliance with the ADA,this application is available in other formats for persons with disabilities.
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 APR 2 5 2022
301 CENTENNIAL MALL SOUTH
PO BOX 95046 NEBRASKA LIQUOR
LINCOLN, NE 68509-5046 CONTROL COMMISSION
PHONE: (402)471-2571
FAX: (402)471-2814
Wcbsite: www.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.
4600 Innovation Drive
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, 1634.
****Please Submit this form wi h your completed application to the Liquor Control Commission****
Trade Name u 0.5 n I _Sf/e 1, 5 nJt
Name of Person Bein Fine 'nted: 1d e ri71 . n
Date of Birth: Last 4 SSN:
Date fingerprints were ken: �;L, ( 3, b. a
Location where fingerprints were taken: 4'// S., /old 1i_51 rev.'1)6 rn AxJ IJ/. b S"7
How was payment made to NSP?
QNSP PAYPORT OCASH OCHECK SENT TO NSP CK#
My fingerprints are already on file with the commission—fingerprints completed for a previous
application less than 2 years ago? YES O
SIGNAtJRE REQUIRE OF PERSON BEING FINGERPRINTED
FORM 147
REV JUNE 2021
4/29/22, 12:26 PM Enterprise Mail-MANAGERS APPLICATION FOR OMAHA CITY COUNCIL HEARING-JOSLYN CASTLE
GmailCarman Johnson (CCIk) <carman. ohnson cit ofomaha.or >
MANAGER'S APPLICATION FOR OMAHA CITY COUNCIL
HEARING - JOSLYN CASTLE
1 message
Carman Johnson (CCIk) Fri, Apr 29, 2022 at 12:10
<Carman.Johnson@cityofomaha.org> PM
To: jalderman@joslyncastle.com
Cc: ALDERMANJUDY45@gmail.com
Bcc: "Elizabeth Butler (CCIk)" <elizabeth.butler@cityofomaha.org>, "Kimberly Hoesing
(CCIk)" <kimberly.pulliam@cityofomaha.org>
Good afternoon
RE: JOSLYN CASTLE TRUST, INC
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, MAY 24, 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 JUDITH M. ALDERMAN. 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
https://mai I.google.com/mai I/u/0/?ik=cd387c45e138:view=pt&search=all&perrithid=thre 3c 1-a%3Ar8697983065138604580%7Cmsg-a%3Ar67736047897... 1/2