RES 2002-1150 - Appoint John A Peterson Jr manager of Eagles Frat Order #154 'STATE OF NEBRASKA
4 s8s eiy,rF, NEBRASKA LIQUOR CONTROL COMMISSION
v Forrest D. Chapman
r7 �,,�,, �.y'?• Executive Director
'r
301 Centennial Mall South,5th Floor
1%•� � "�^�'�;, P.O.Box 95046
• Lincoln,Nebraska 68509-5046
1 y4.RC C L Phone(402)471-2571
B fd fie-
. Fax(402)471-2814
TRS USER 800 833-7352(TTY)
Mike Johanns web address:t://www.nfarg/home/NLCC/
Governor S %3
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April 19, 2002 • - -< '
i71 ram- PV P1
City Clerk
Omaha/Douglas Civic Center
1819 Farnam LC-1
Omaha NE 68183
RE: Manager Application Submittal
Dear Sir/Madam:
The enclosed Application for Manager is being submitted by Eagles Frat Order#154
located at 2226 "N" Street, Omaha, NE 68107 (Douglas County) which holds a Class C License
#01332 the applicant's name is John A. Peterson,Jr.
Please present these applications to your City/County Council and return to us the results
of the action taken. If you have any questions or comments, please give me a call.
Sincerely,
•
Michelle Petersen
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
•
' RPR 17 '02 El:24PM NE LIQUOR CONTROL � P.12
AILUd
pplication for Corporate Manage 9'1ECI�
*Must Be A Nebraska Resident„ , ED
Please submit In Triplicate ( �())
Saturn to; Nebraska .._-. . ... ,,. ,. • PO Bo:MOO � �`Y'7 Zd0I U if
301 ••. So, '• NE 61309 •
phone:(402)411- 11saR(1112)4714114 atldPNV IdtgriMtveal.or o®e1NLCG iR�M�
LIQUOR LICE N
NAME.OF LICENSED CORPORATION CLASS dt LICENSE NUMBER .i
's Ie s FA; 7- Orel ex '�`�s�14. c,'4 ss K��� — #0J33a
iliADEIIAME Of LICO3NSED PREl4l5E
Ed&5 Fr fit Order *J$ o�
ADDRESS OF Ltd 1ED PREMISE do COUNTY OODE
a 10 N ..fie+ tip ®m AyIA 6l` bovl%‘h5 e>t bA 10-7 oe.
On behalf of die ca potadoe,I desiprxe ids Individual,eeiporarn
Signature of Corporate PretrfdelrtlCEO: - /j
/e:... ...:c. ,
C/r
—'—� ANt*CANT INFORMATION(MUST BE Z1 OR OVER)
NAME(LAST,FIRST,MIODL8►MAIDEN) SEX SOCIAL SECURITY NUMBER DATE OP BIRTH ACE OF BIRTH
FiTErsOn),�R. •5c}Rf1 Ar�d.re10 F R_ • ///03�e° ViA4 ,Mob
HOME STREET ADDRESS CITY COUNTY STATE VP CODS 1
•
v25-4, ', F street OrngtA bow% Al NEE. (ogr07 .
HOME TELEPHONE!w ER BUSINESS TELEPHONE NUMBER LJC 13C NUMBER a STATE
<�o� 733- 07 (i4 8a9-3989 013090a7 Nob
5 MEW INFORMATION(IF NOT MARRIED INDICATE NONE)
FULL NAME(LASE FIRS`M EDfA MAIDEN) • SOCIAL SECURITY NUM MI • DRIVERS LICENSE NUMBER
&STATE
Uc ive No M5 riloNE
'DATE OF BIRTH: Noe. V PLACE OF BIRTH: No'E. '
I ,
I.READ CAREFULLY—Answer completely and eermare1y.
Has anyone who is a party to this application or their spouse.Paz been convicted of or plead guilty to any ethnical c1 s ge?Criminal
charge streets any sharp aaeg •*logy or misdemeanor violation of a fedaei or state law;or a violation of a local law,ordinance or
ioaoludoah•I,Ms the tent of the Marge,where the dame oaeuv ed and she yaw and month of the conviction or plea.Alto list any
charges pondlt at the dale of dda rpplicatlott.If more thin one pasty,please list charges by eech individual's stmt.
D YES ilt NO
2 Eltve you or Pm spoon oar made application for any liquor license cr manager for rely liquor license?IF YES,for what premise
give lloet+rs number and daans•
Cl YES IX NO _ .
_ _ aa�.doi
PliGE;
L/ l e6ed ° IZ:OI ZO-Bi-udtl ! L99C Z6Z ZOb : :AB zuag 1
3.. Have you.or your spouse ever made a compromise settlement for violation of such laws?
❑ YES ►.l NO (L ' r
. 14
4. Do you, as a manager,have all the qualifications required by any person entitled to hold a Nebraska Liquor License? Li
Nebraska Liquor Control Act(§53-131.01)
•
XI YES ❑ NO .
5. Have you filed fingerprint cards and PROPER FEES(if check,made out to the NE State Patrol), with this application?
0 YES ; ❑ NO .
•
"'.! "' LIST PRINCIPAL`ORFSIDENCE FOR PAST 10 YEARS;'A PLICANT ANY)SPOUSE-MUST,COMPLETE
. ti . :r' .. B"".t. . •"'.,,,'-,,t`,' ri �`?. e,. 'i'' t' - - t-1 t ,yi V4 '''.:••.' ' . • '
APPLICANT:CITY&STATE - YEAR SPOUSE:CITY&STATE • YEAR
FROM TO • • FROM TO
c 4A,Q /Lieb,. 1989 aooa
.. F. e ' . - -
..'. . . " 6t. .i.?"'EMPLOYERS LIST LAST-TVVO°EMPLOYERS '°.. --` '
yep`"�t 'tsM'w'it"-e..-4o .,-.i4 � ..�.^*�'� .k-71t'4+7"``S;'`1 14,04 FM'l'4,4'`.c G Y.r/:... „:p#,►F'.* ..:4"}�'t*+C.4 wr ..-..•'Ll•s,.:..*. + .... .
YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER
FROM TO
19`7 amz 3 ,x-G flik �'It�ci- • A`7' oR_ 5esr-i qag-8ag-3asa
e.d '' •C i', -.i .�.t': ' - y ,�. .a {+-r''R. •_u (..��
a .PERSONAL OATH AND CONSENTAOF INVESTIGATION- MUST BE SIGNED•BY APPLICANT&SPOUSE
..'.,`:—;•4..,.4.-.-...,...: •. l'.2-wi".....4.Gr?:.. `.1. F.4' Li? v V :..Y1.,,-:.e.i.:,..,A.i ...r,. _: ..._.._• t.-R.I.- _a--.:{'.. <__.. ._,
STATE OF NEBRASKA )
) SS
COUNTY OF )
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,an affidavit may be attached however,fingerprint cards are still required to be filed. .
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 and inaccurate.
•
9 ... Sill_ • NO
Signature of Applicant Signature of Spouse(if applicable)
Subscrib,0.„ y .resence and sworn to before me this 6 Subscribed in my presence and sworn to before me this
day of .mil/► t - ? I _ . • day of .
R
ili!firri"."1-44111#111141111{7."."----- -- 4..
.:E.44µ1 ARTHUR`r1;, c!•.= p:ture1' eal Notary Signature&Seal
..,,y,.�.,...;a.`�l IfY COMMISSION EX,PIRES •
I'•y,1sid/` �cvtl�7 FORM 35-4013
REV.8/01
. PAGE 2
• •
MAHA. N
o Omaha City , Webras a C.�_� 7
Direr"%k ri
1819 Farnam-Suite LC 1 i zji u ,,,
Omaha, Nebraska 68183-0112 o �� ,tea ";_M,
Buster Brown (402) 444-5550 .o 'v
City Clerk FAX (402) 444-5263 o4,41sk.0FEBR'3>
April 29, 2002
Eagles Frat Order#154 Application to appoint John A. Peterson, Jr.
2226 "N" Street manager of your present Class "C"Liquor
Omaha,NE 68107 License
Dear Liquor License Applicant:
This letter is notification that a hearing before the Omaha City Council on your
application to appoint a manager to the liquor license has been set for May 7, 2002. The
City Council Meeting begins at 2:00 P.M. in the Legislative Chamber, (LC-4),
Omaha/Douglas Civic Center, 1819 Farnam Street, Omaha, Nebraska. City Council
Liquor Rule No. 6 states, "Each applicant for any type of license shall be personally
present in the Council Chambers, in order that the Council may make inquiries, on the
date of public hearing of the application for said license". Failure to be present at this
Council Meeting is grounds to recommend denial of your application to the Nebraska
Liquor Control Commission.
City Council Rule No. 14, requests each applicant to submit a signed statement
representing that a sign indicating the birth date for buyers of alcohol will be prominently
displayed on the licensed premises and that approved training in the proper procedures
for checking buyers'. identification will be provided to employees. Attached is the
statement to be signed and returned (hand deliver, mail or fax) to the City Clerk's Office
before your public hearing. FOR YOUR FILE.
ATTACHED SENT TO THE MANAGER.
Sincerel yours,
iA461) ,
Buster Brown
City Clerk
BJB:clj
OMAHA, NF
40'4,City ofOmaha, Webraska I °��
1819 Farnam—Suite LC 1 2 allrar
0/ik. =1.4,1 �,
Omaha, Nebraska 68183-0112 ®. '
Buster Brown �PA Ir
City Clerk FAX (402) 444-5263 4,1 � 41-
'
FD FEBR
April 29, 2002.
John A. Peterson,Jr. Application to be appointed manager of the
2516 "F" Street Class"C"Liquor Licenses for Eagles Frat
Omaha,NE 68107 Order#154, 2226 "N"Street
Dear Liquor License Manager Applicant:
This letter is notification that a hearing before the Omaha City Council on your
application to be appointed manager of the liquor license has been set for May 7, 2002.
The City Council Meeting begins at 2:00 P.M. in the Legislative Chamber, (LC-4),
Omaha/Douglas Civic Center, 1819 Farnam Street, Omaha, Nebraska. City Council
Liquor Rule No. 6 states, "Each applicant for any type of license shall be personally
present in the Council Chambers, in order that the Council may make inquiries, on the
date of public hearing of the application for said license". Failure to be present at this
Council Meeting is grounds to recommend denial of your application to the Nebraska
Liquor Control Commission.
City Council Rule No. 14, requests each applicant to submit a signed statement
representing that a sign indicating the birth date for buyers of alcohol will be prominently
displayed on the licensed premises and that approved training in the proper procedures
for checking buyers' identification will be provided to employees. Attached is the
statement to be signed and returned (hand deliver, mail or fax) to the City Clerk's
Office before your public hearing.
Sincerely yours,
eLC
Buster Brown
City Clerk
BJB:clj
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