RES 2022-0736 - Appoint Lucas E Hiatt manager of 402 Eat + Drink •
E-MAILED TO NLCC a "3
04.,04,E Sr rF sh - - _. - - --- -- - -- -- -- -
- STATE OF NEBRASKA
_ I Pete Ricketts NEBRASKA LIQUOR CONTROL COMMISSION
; _�i '-":.11 Governor Hobert B.Rupe
h '" Executive Director
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: July 05, 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: 402 Eat + Drink LLC
Trade Name (DBA): 402 Eat + Drink
License Number: C-I 23258
Manager Name: Hiatt, Lucas E
Due Date: August 19, 2022
FA APPROVED
F NO LOCAL RECOMMEND!,TION
•
El DENIED
COMMENTS: (YOU MAY ATTACH MINUTES AND/OR ADDITIONAL NOTES)
}" �5 2022- CL3LP
Clerk's Name: Date: R- 3 Z'Z_.
Kim Lowe Bruce Bailey Harry Hoch
Commissioner Chairman Commissioner
Ai Equal Opportunity Employer
MANAGER APPLICATION Office Use �
INSERT-FORM 3c RECEIVED ,;
NEBRASKA LIQUOR CONTROL COMMISSION
301 CENTENNIAL MALL SOUTH JUL 0 5 2022
PO BOX 95046
LINCOLN,NE 68509-5046 NEBRASKA LIQUOR
PHONE:(402)471-2571
FAX:(402)471-2814 CONTROL COMMISSION
Website:www.lcc.nebraska.gov
FORM MUST BE COMPLETELY FILLED OUT IN ORDER FOR APPLICATION TO BE
PROCESSED
MANAGER MUST:
4/ 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
1 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: US birth certificate,naturalization papers or current US
passport,(even if you have provided this before)
jBe 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-
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
2200007599 �
Farm
Rev 201 S
4V Page 1 af 6
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Manager's information must be completed below PLEASE PRINT CLEARLY
Lut Name, r Eirct Name: Lc,s,
Herne Addros: k_3.31S „Li osl 30.5
_
City:
County: bon. ,4.., _ Zip Coyle: (t) Lk
.0.rA.Y.A\k"--
lome Phoue Number: 1‘7.- 305 t 25
oi.vei.5 License Number& Statc1.1.1111111
Social Security Number:
Date Of Birill:11111111111111111 Place Of Birth: t Ob../1C-% gl Wift, I ft
11.1noil arldres3:
Are you married?If yes,complete spouse's information(Even if a spousal affidavit lias been.submiUed)
YES tF4..NO
Spouse'f•inCormation
Spouies l.ac N am e: First Name: MI:
Security Numbei.
Drivc:'s beenNe Number& Stale:
fl;ne Or Rim it. Plaea Of Birth:
APPLICANT&SPOUSE MUST LIST RESIDENCE(S)FOR THE PAST TEN(10)YEARS
A PPLICANT SPOUSE
CITY&STATE 1 l'EAR YEAR 1
FROM TO ! CITY&STATE 1 YEAR 1 YEAR I
FRONTI,_TO I
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ltrriaho 1/010
2ADN
.• MAN- AGEIVS.EAST TWO EMPLOYERS • .
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YEAR 1 TELEPHONE
NAME OF EMPLOYER l NAME OF SUPERVISOR FROM TO NUMBER
lyfii:, 1,„1,,s, , 44-Aii-i-ii,to 1
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I. READ CAREFULLY. ANSWER COMPLETELY AND ACCURATELY.
Must be completed by both applicant-and.spouse unless spouse has filed an affidavit of non-
participation.
Has any.ate who is a party to this application,or their spouse,FVF:R been convicted of or plead eiliity to any Oarge.
Charge means:jttx charge allegina a felony.misdemeanor.tmlation of a federal or state law:a violation of a local,law,
°idiot:lice or resolution. List the nature of the charge,where thecharge occurred and the year and month orate conviction
or plea,include traffic violation . Ako list arty charges pending at the time of this ilpplication. If mote than one party,
please list changes by each individual name. Commission must be notified of any arrests andfor convictions that may
occur aftet the date of signing this application.
Eil VF.S Li NO
If yeS,please explain below or attach a separate patte. .
1 Date ol I Where Description . --
Name cif Applicant I Conviction Convicted
of Disposition
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2 Have you 44-your spouse ever been approved or made application for a liquor lictmse in Nebraska or
any other state?
flY ES S'Ci 0
IF YES,list the name of the pretnisets):
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3. Do you,as a manager.qualify under Nebraska Liquor Control Act t,,; ..- .(j j and do you intend to
supervise,in person,the management of the business?
tYhS NO
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4. t.isz the ale.ohol related training.ancl:nr experience(when and where)of thc person making application.
ND-I:Training Certificaie trailed: same on Certificate:., .
Applicant Name PuttlY.YYY)H- Name of prograrn(attach copy of course completion( 1
I eeniticate) i
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For Icat or NI.CC.Certified Training Progrorris AT%Mining
Experience:
1)atc of I
Applicant Name%Job Title Name.&Locadoti of Bit:sit-toss:
Entployrnent: l
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5. Have you enclosed form 147 regarding fingerprints?
IYES EINO
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PE1tSONAL 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 identificatiop record are set forth in Title 28, CF'R, 16.34.
ds'
Signature of Manager Applicant Signature of Spouse
ACKNOWLEDGEMENT
State of Neb sk_a, L
County of Ut 1 Ula I O.S The foregoing instrument was acknowledged before me this
by Luke to
date NAME OF PERSON BEING ACKNOWLEDGED
_ Affix Seal w �rlorurr-staiteo+se>x�
Notary ublic signature praOLECONNER
r._._. iftCrAnIn.t Septerttber1a2t125
-
in compliance with the ADA,this application is available in other formats for persons with disabilities.
A ten day advance-period is required in wr:sting to produce the alternate format.
born,103
Rev July201R
Page 6 of 6
PRIVACY ACT STATEMENT/
SUBMISSION OF FINGERPRINTS / RECEIVED
PAYMENT OF FEES TO NSP-CID
NEBRASKA LIQUOR CONTROL COMMISSION JUL 0 5 2022
301 CENTENNIAL MALL SOUTH
PO BOX 95046 N.EBRASKA LIQUOR
LINCOLN,NE 68509-5046 CONTROL COMMISSION
PHONE: (402)471-2571
FAX: (402)471-2814
Website: www.lec.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—CI.D Division
4600 Innovation Drive
Lincoln,NE 68521
• Fingerprints taken at NSP LIVESCAN locations will be forwarded to NSF—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 FR identification record. The procedures for obtaining a change, correction, or updating
a FBI identification record are set forth in Title 28, C'FR, 16.34.
****Please Submit this form with your completed application to the Liquor Control Commission****
Trade Name 02, E./i(+ n v . r
Name of Person Bein Fin er rinted: L U J� (�1(t T•
Date of Birth: Last 4 SSN:
Date fingerprints were taken: •
Location where fingerprints were taken: S?
How was payment made to NSP?
NSP PAYPORT ❑CASH ['CHECK SENT TO NSF CK#
y fingerprints are already on file with the commission—fingerprints completed for a previous
application less than 2 years ago? YTS ❑
SIGNATURE REQUIRED OF PERSON BEE. G FIN ERPRINTED
FORM 147
REV JUNE 2021
7/6/22, 12:14 PM Enterprise Mail-MANAGER'S APPLICATION FOR OMAHA CITY COUNCIL HEARING-402 EAT+DRING,LLC
,hGmail Carman Johnson (CCIk) <carman. ohnson cit ofomaha.or >
MANAGER'S APPLICATION FOR OMAHA CITY COUNCIL
HEARING - 402 EAT + DRING, LLC
1 message
Carman Johnson (CCIk) Wed, Jul 6,2022 at 11:33
<Carman.Johnson@cityofomaha.org> AM
To: INF0@eat402.c0m, LUKE_HIATT@yahoo.com
Bcc: "Elizabeth Butler (CCIk)" <elizabeth.butler@cityofomaha.org>, "Kimberly Hoesing
(CCIk)" <kimberly.pulliam@cityofomaha.org>
Good morning
RE: 402 EAT + DRINK, 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, AUGUST 2, 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 LUCAS E HIATT. PLEASE SEND ME
THIS INFORMATION AS SOON AS POSSIBLE.
Please notify me if have anY questions.
you
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://mail.google.com/mail/u/0/?ik=cd387c45eb&view=pt&search=all&pen n thid=thread-a%3Ar1390001904686770348%7Cmsg-a%3Ar-9112949663... 1/2