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RES 2022-0737 - Appoint Jotham E Brown manager of Sullivan's Steakhouse E-MAILED TO NLCC k-3 - o 2.9- ifip' TEE•*�i4 ''� STATE OF NEBRASKA '`' -- .'0 i Pete Ricketts NEBRASKA LIQUOR CONTROL COMMISSION R y f•P':AfIA,_ ',1 ; Governor Hobert B.Rupe ;ti Executive Director tWbykctiS 301 Centennial Mall South P.O.Box 95046 1 • 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 01, 2022 From: Lisa Steward (Lisa.Steward@nebraska.gov) To: City Clerk of Omaha 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: Sullivan's Restaurants of Nebraska LLC Trade Name (DBA): Sullivan's Steakhouse License Number: 1-076711 • Manager Name: Brown, Jotham E Due Date: August 15, 2022 APPROVED NO LOCAL RECOMMENDATION El DENIED COMMENTS: (YOU MAY ATTACH MINUTES AND/OR ADDITIONAL NOTES) ZL ,€,e, 2.D22-D3 ./0s usJ--..2, zZ Clerk's Name: Date: a' ZZ, Kim Lowe Bruce Bailey Harry Hoch Commissioner Chairman Commissioner An Equal Opportunity Employer MANAGER APPLICATION ottirot>x RECEIVED INSERT-FORM 3c NEBRASKA LIQUOR CONTROL COMMISSION JUL 01 2O' 301 CENTENNIAL MALL SOUTH PO BOX 4ti LIQUOR LINCOLN.NF,68509.5046 r FAX.(40407)471.2571 CONN 1 R FAX.f40<)471-2R14 VtY 1 V COMAaISSION Websne:www.lce:nebraska.go�`. I Yt[ FORM MUST BE COMPLETELY FiLLED OUT IN ORDER FOR APPLICATION TO BE PROCESSED MANAGER MUST: '' c. ,complete all sections of the application. Be sure it is signed by a member or corporate officer. l/corporate officer or member must be an individual on file with the Liquor Control Commission • rfngerpnnts are required. See form 147 for further information,read form carefully to avoid delays (fin processing,this form MUST be included with your application. i Pravide.g copy of one of the following:US birth certificate.naturalization papers or current US cpissportleven If you have provided this before) • e a registered voter in the State of Nebraska.include a copy of voter card or print document from Secretary of State website with application,. .(Y.:A, A, ;'1 j y WI 1 fry Spouse who will not participate in the busindis..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=l of the application Spouse who will participate in the business.the spouse must:, • Sign the.application ,, • Fingerprints arc required. Sec form 147 for further information,read fort carefully to avoid delays jt�;, 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 voice card with application • Spousal Affidavit of Non Participation Insert not required •i471 Form tit? 2200007370 11 6%364 i0t6 Pare l of • MANAGER APPLICATION R CEI INSERT-FORM 3c NEBRASKA LIQUOR CONTROL COMMISSION ,J U L /t-t 2022 301 CENTENNIAL MALL SOUTH V J PO BOX 95046 N 04-Scab COMMISSION - PHONE.(402)471-2571 NEBRASKA LIQUOR CONTRottfAX,(dn2)d71-2A1a Wcbsite.www.lcc.nebraska.gar MUST.BE: I 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 n cbsitc ✓ 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 Corporation/I-LC information Name of Corporation/LLC: �I I� jti,l' -EftIG t.,t i 1 :'7 1 j Premise information rf Liquor License Number: 07 to.7I.I Class Type 1 tit new appticom Icne blank) C Premise Trade Nametl)BA: . )i I VL4 f1•S �'t'4?LA IC..h C(.75P Premise Street Address: ZZ?. 5 /S 51. City: ()ma ho. County,__Dix.ffi `" Zip Code: lc'IG2.. Premise Phone Number:. (,.4OZ' 3 y2 -0G77 Premise Email address: .15 32. it>,fctt1S Sktex►LhotJ .Li_t 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. '',vim . SIGNATURE REQUIRED).BY CORPORATE OFFICER I MANAGING MEMBER (Faxed signatures are acceptable) L.f torn 103 ac.Jxli zais Page 2 ore Manager's information must be completed below PLEASE PRINT CLEARLY Last Name: (CLkAn First Name: d;CkhatrY1 Ml:- Home Address: (ZCr >dk Ade._ City: _ ,JE.I tC,JUP County. Ct,c rp'y Zip Code: /{123 Home Phone Number_,QL' _Z "Li y ss..__. ., ._ Dnver's License Number&State: Social Security Number: - Date Of Birth: Place Of Birth: !jii e, k de ev Email address: />}A t't'1, at C }..(1 t. E Ain.Yt3pmarried?If ye-4r complete spouse's-information(Even if a spousal,affidavit has been submitteilY OYES NO Spouse's:information Spouses Last Name: RI—IA.4 First Name: Ann Ml: Social Security Number:_ Driver's License Number&State: Date Of Birth:., Place Of Birth: SR A'On (2cc)q e , LA APPLICANT&SPOUSE MUST LIST RESIDENCE(S)FOR THE PAST TEN(10)YEARS ;;'` PLICANT SPOUSE CITY&STATE YEAR YEAR` CITY&STATE YEAR YEAR I FROM TO 1 FROM TO 6trOt ,lk ! AJ ?.caw zctoi Sprir P(Ol, 1Y-10 7ct� _VA(01 Fo,nr UK; Rn 1uh?rus Part 3 of b MANAGER'S LAST TWO EMPLOYERS FROM YEAR I TO I NAME OF EMPLOYER. NAME OF SUPERVISOR TELEPHONE NUMBER 'LC' ZCU.4 5,,ttit;on 3 S ,i.V&c' ., Sthn ;51r:.4nt21/4/ _ LSO) i 3Y- • Zt.l' 2e► I arnG*k kt Mort •i?x)( `e-r 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 it a party to-this application.or their spouse,EVE'12 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.lart. 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 t'iolatitins. 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 } Itnnif yyy) t City&State) ! Charge .,.)'o/4"4.,M 13r O(,, � t 1 ,Vt�'tD kit AJL"t � i/��l I I" fgrO _ © /2.0 '7 Kid tr�t�gA�NG Ron ,Lett. l�'itiL. l ]i] jj ( 1 2. Have you or your spouse ever been approved or made application for a liquor license in Nebraska or any other state? DYES 4NO IF YES,list the name of the premisets)• 3. Do you,as a manager.qualify under Nebraska Liquor Control Act R,5371 IA,tlj and do you intend to supervise,in person.the management of the business? IYES []NO Form tos Rik July 2045 •Pagta of • • • 4. List the alcohol related training and/or experience(when and where)of the person making application. 'NLCC Training Certificate Issued: 06/17/2022 Name on Certificate: Jotham Brown Date Applicant Name Name of program(attach copy of course completion (mrnlYYYY) certificate) Jotham Brown 06/17/2022 , ServeSafe Alcohol • 'For list of NLCC Certified Training Programs see training Experience: --r— Date of--�------------ pl Applicant Name"Job Title E Date Name&Location of Business: Jotham Brown,General Manager 07/22/2020 Sullivan's Steakhouse 222 S 15th St.,Ste 100 Omaha,NE 68102• - i 5. Have you enclosed form 147 regarding fingerprints? BYES ONO • • Form 10? Rev July 201g Page a of T 1 _ 1 1 ,7p . k )iiit.., .__Iu'IP(51f1L'ii .Qii,fg__, ,11,5 4!1I'(iEwk-14a1 :r:t.1r► t` rele[-�'!i lilt cjfr tl =i �Ll!1�1rj'J*T ;rr ,rI. /.i��,t)...>-�. f• tt .iI`t::)a . t)/r II :g 0iYll!+"a1n:q.,Kit tea is,:ski .:F.`3 �:�►ittili,.111- ,Iliktii jj j- "•i. ',J S..ft:'i., p CJtL!},�[I;':(RtiI:`ij_!����:i•1i11-.�`�.�1��'ti, �Y�J���1 i!i•����i�fCd.l (�,'�► �1`I Thank you For participating in the ServSofe Alcohol program.Responsible alcohol service begins with the choices you make,and ServSafe Alcohol training will help you make the right decision when the moment arises. By completing th4,ServSafe Alcohol program,you show your dedication to safe and responsible alcohol service.The ServSafe Alcohol program and the National Restaurant Association are dedicated to helping you continue to raise the bar on alcohol safety. To learn more about our Full suite of responsible alcohol service training products, contact your State Restaurant Association,your distributor or visit us at ServSofe.com. We value your dedicati?n to responsible alcohol service and applaud you For making the commitment to keepyour operation,your customers and your community safe. tOrr. Sincerely , 1444.04104,0„,,.\....../ 22 Sherman Brown ar t) Executive Vice President,. B itonet Restaurant Association Solutions . t i w,r,�..,1.t,.�-._�.�.-. .. ., r. ... .. l tt NOTE:You con access your score t� �"�� ID f"""" and certification information anytime 01 -. is f € ServSafe CARD=CM att ��rlir If you have any questions regarding your certification please contact the v ' • ServSafe Alcohol® CERTIFICATE Notional Restaurant Association srs. , : 144' Service Center at a/ .10714221111204444 :,C.. ter"-..: L ':....�'..:y. 4. or r ,1,.. NAME .;" 1,SI rya;.-,;a IrZ Ela n2022 IP -1 ' t • <, * DATE OF EXM'INATION `= f,i• I� " rd eon ens vas te wee interne ladling* s F r'-- y+ i + Hat ICi0llll ' Yr►aras+iP�1ellspPrW°n� . ' 4 , r. atr+vi:arpNawensaanrsaaron►iPAM'WMrpP' sg del►PSeSrW w t r►„,nu, tams,szeal nYJ3UNlsos►pMJ WOO'sountm32r►mrsssgNONLIOZ. c sum n17S ug7n1V lunme7aau I*aai7eN-magmata NiA annluaz3 t° j�` r ' t •woj6ord erns pyoao efgtsuodsai 4(40,re*PSA. S 01N f°uaplduroo suuyuc°..09!ue'cm. 1 . " ,1-....:,.., rcoy I -.__ -- _i, In Alaska y, must Iaminaip your card for it to be v0Bd. l . �_ i. r`'�1F. t: _� r.,u.r} . - 1.-t•tr..11 t.c. �� ' r 7t�1 :714 r t`t" -r r f .3s i:). I 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 he used to check the criminal history records of the FBI. You have the opportunity to complete or challenge the accuracy of the information contained4n FBI identification record. The procedures for obtaini g a chang rrection,or updating an FBI identiAcar nn record are.set forth in Title 28.CFR, 16.34. 1 na '1 of Manager Applicant Signature pouse • ACKNOWLEDGEMENT State of Nebraska I County of DOI.51 CIS The foregoing instrument was acknowledged before me this JJo+l\o C Inv/ rye date by; Vd h E Noun : (417117s L .btotal NAME OF PERSON BEING ACKNOWLEDGED • J Affix Seal Notary Publi ienattlre 1 GENERAL NOTARY•State of Nebraska LORI MILES ` My Comm.Exp.January 13,2023 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 20111 Page 6 of 6 SPOUSAL AFFIDAVIT OF ntpeel:.e REC E VEU NON PARTICIPATION INSERT NEBRASKA LIQUOR CONTROL COMMISSION 301 CENT'E\'VIAL MALL SOUTH ({I (t �lft 1 1 PO BOX 93046 ..t LJ Cr L U L L LLNCOLN.NE 6$50Q San PHONE,(402)471 371 [}r�/� y/"/ 7 i FAX(40:)47}.2s14 -NEBRASKf° LIQUOR. A'etxite wxw.la.nt',rnala.jto: `ti CONTROL COMMISSION I acknowledge that I am the spouse of a liquor license holder. v1y signature below confirms that T will not have any interest.directly or indirectly in the operation of the business 053-125(131)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. raI acknowledge that i am the applicant of the non-participating spouse of the individual signing below. I understand that my spouse and 1 are responsible for compliance with the conditions set out above. II. it is determined that my ou. has violated(§53-125(13))the commission may.cancel or revoke the liquor license. .r. • ;1 7 , , ,..c.14-7-- .... Signature of NON-P TICiPATING SPOUSE L ores SYnat a of PPLICANT Arrlht i' r 1 c hc�rYl -F. �ji c ta-1 Print Name Pnnt Name State of Nebraska.County of f State of Nebraska.County of_l, QS The foregoinginstrument was acknowledged before me The foregoing Instrument was acknowledged before me this iLO411 o-c' MAI t ). (date) this c) - (date) by_ilyi 'r L . (3SO'A:v*1 by,_)0+) ,ry1 !-' btt1 4011 Name of person acknowledged Name of person acknowledged (individual signing document) (Individual signing document) ( apo2aL • or ry Public Signature i4t(FAAL NOTARY.Sate ofOt tssselm t;r llaLworW-sraroulooailm Am l MILES LgptA SS M ytbrtatifaa.8miaylt,T027 , MYCcem.Bp.km7112023 In eompiianre with the ADA.hie apoaaat AM..ornon rantrtpattrw 6 acedahlt to other formats.for,peroor.urth d,sabihots A its day advance prnod is requested to;wooly to pro-dote the altemste tonsil VVV FORM 116 REV NOV 2016' Page,I. RECEIVED PRIVACY ACT STATEMENT/ SUBMISSION OF FINGERPRINTS/ JUL. 01 2022 PAYMENT OF FEES TO NSP-CID NEBRASKA LIQUOR CONTROL COMMISSION NEBRASKA LQUOPi 301 CENTENNIAL MALL SOUTH PO BOX 95046 CONTROL COMMISSION LINCOLN,NE 68509-5046 PHONE:(402)471-2571 FAX:(402)471-2814 Nchotc n to ict.ndhra<ka-gnt THIS FORM IS REOUIRED TO BE SIGNED BY EACH PERSON BEING FINGERPRINTED DIRECTIONS FOR SUBMITTING FINGERPRINTS AND FEE PAYMENTS: • FAILURE TO FILE FINGERPRINT CARDS AND PAY THE REOUIRED 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 ssws�.nc.gos 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 • Ftngerpnnts taken at NSP LIVESCAN locations will be forwarded to NSP-CID Applicant(s)will not have cards to ins hcde 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 Challenier Your.frngerprints will be used to check the crinunal history records of the FBI. You have the apporyunrr to complete or challenge the accuracy o/the information contained in the FBI identification record. The procedures for obtaining a change,correction or updating a FBI ldenti(icatidn record are set fortlr in title 28.CFR,.16 34 "'Please Submit this form with sour co'x<pleted application to the.Liquor Control Commission**** Trade Name__.J Oli,‘,',AA 5 ilc4)a 50. Name of Person ei Fine ri ted: :Sr khClM 6c.,tA-3n , __ Date of Birth: Last 4 SSN: Date fingerprin s were a cen: Location where fingerprints were taken: cS,s9, .L. How was payment made to NSP? IIINSP PAYPORT 1g1CASH OCIIECK SENT TO NSP CK# My fingerprints are already on file with the commission—fingerprints completed for a previous application le`s iha-. )ears ago?YES 0 SIGNAJUR- EQUIRED OF PERSON BEING FINGERPRINTED FORM 147 REV JUNE 2021 7/5/22, 11:44 AM Enterprise Mail-MANAGER'S APPLICATIC:I'FOR OMAHA CITY COUNCIL HEARING-SULLIVAN'S RESTAURANT '; Gm Carman Johnson ICCIk) <carman.johnson@cityofomaha.org> MANAGER'S APPLICATION FOR OMAHA CITY COUNCIL HEARING - SULLIVAN'S RESTAURANT 1 message Carman Johnson (CCIk) Tue, Jul 5, 2022 at 11 :43 <Carman.Johnson@cityofomaha.org> AM To: 8532@sullivanssteakhouse.com, JOTHAM.BROWN@sullivanssteakhouse.com Bcc: "Elizabeth Butler (CCIk)" <elizabeth.butler@cityofomaha.org>, "Kimberly Hoesing (CCIk)" <kimberly.pulliam@cityofomaha.org> Good mid morning RE: SULLIVAN'S RESTAURANT OF NEBRASKA, 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 JOTHAM E. BROWN. 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 https://mail.google.com/mail/u/0/?ik=cd387c45eb&view=pt&search=all&permthid=?h read-a%3Ar4217538924417318055%7Cmsg-a%3Ar-2506217193... 1/2