RES 2002-1152 - Appoint Rancis M Mercer manager of Indian Oven •
5TATEOFNEBRASKAFCE ! VE {)
,/;�x::sT NEBRASKA LIQUOR CONTROL COMMISSION
02 A e Forrest D. Chapman
47 C3 ' Executive Director
t 301 Centennial Mall South,5th Floor
t�'',�$`/ -`tee''') P.O.Box 95046
� CITY CLt
s, Lincoln,Nebraska 68509-5046
��'., �IRCB INa _% {1 r� d L B Phone(402)471-2571
+s K Fax(402)471-2814
TRS USER 800 833-7352(TTY)
Mike Johanns web address:http://www.nol.org/home/NLCC/
Governor
April 17, 2002
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 Indian Restaurant&
Associates DBA Indian Oven located at 1010 Howard Street, Omaha, NE 68102 (Douglas •
County) which holds a Class I License #11966 the applicant's name is Francis M. Mercer.
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,
'! 4/W
'chelle 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
Loco
-9
, Application for Corpora, 10 :,. 1 \JED
*Must Be A Nebraska Resident* • E D
Please submit in TriplicateApR 1 -i*
Return to: Nebraska Liquor Control Commission,PO Box 95046
301 Centennial Mall So.,Lincoln NE 68509 NEBRASKA U000' P 1 1 002
Phone: (402)471-2571 Fax: (402)471-2814 Web address: http://www.nol.okftratI0(V11SS10N
NFBRASIV!LIQUOR
LIQUOR LICENSE INFORMATION CONTROL COMMISSION
NAME OF LICENSED CORPORATION CLASS&LICENSE NUMBER
1 \% M NJ RE STMA Ai ► AsS o C(AT1 S I_ 1(61 6 P
TRADE NAME OF LICENSED PREMISE
(MbIk-r. OUEt
STREET ADDRESS OF LICENSED PREMISE CITY COUNTY ZIP CODE
1010 1 vJA- S" . O 4AHA DdceGL.A-S ( 0 2
On behalf of the corporation,I designate this individual as corporate manager.
Signature of Corporate President/CEO: l
APPLICANT INFORMATION (MUST BE 21 OR OVER)
NAME(LAST,FIRST,MIDDLE,MAIDEN) SEX SOCIAL SECURITY NUMBER DATE OF BIRTH PLACE OF BIRTH
i (`n,-�L(5.9— - NG-s /hw�K F 1 IZ/y1y3 d �
HOME STREET1 ADDRESS CITY COUNTY STATE ZIP CODE
t l O r. 11 6,,.r A.i? C �� Q � PI Po J&-t-Ik-S N 6 p, L
(d
HOME TELEPHONE NUMBER O BUSINESS TELEPHONE NUMBER DRIVERS LICENSE NUMBER&STATE
(*C. ) -6 4 5 - 01( (HGy) 3 -16 - Yc-1'-!.f 6-o1 i 911,1" 14(;
• SPOUSE'S INFORMATION (IF NOT MARRIED INDICATE NONE)
FULL NAME(LAST,FIRST,/ MIDDLE,MAIDEN) SOCIAL SECURITY NUMBER DRIVERS LICENSE NUMBER
aefe c�, Y 'u-a- G . erl2- 7 &STATE
DATE OF BIRTH: // 3 PLACE OF BIRTH: fir I I Lief ntaiii
y
I. 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 pendin t the time of this application. If more than one party,please list charges by each individual's name.
❑ YES is NO i 1 y , PI t-fiN a cl4►—.,': U'-IaCi.ti t NCLdurC ,liCror` p,(-`°i,Ji..) 3 rT rrr.•.Eti r-
s JL 9tr 2 t o^^A-tvi- 1112, F-kILaa... i - (t'-✓6" P Ji- f`2 3✓rLi),Mc- occ.,,pcir,,1
PL.,- ` I i, rl r % 2c'? 'So L►?co_,J ,.J, utiJan.. ►d(%u.� 'cv NoT Dn,.,',nr'- r11?
A?n►r►% S i fLr-r,r 0 A--• g 2j t-. N S /L•?:'/� "r i i 11 q '
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.
GIES ❑ NO
inA2Kct /L& -ft , (.es'xi-S /JG. ) 'T11 -9i PAtr O.-+NZrt-
To t..I I ,, N`oo "" fPc Pi n w`(- 23 a( 3
FORM 35-4013
6 L P /NA A R-'k cs.1- Cu . ?JJ 1.. -3 c f R PAGE I
262 eRRr► ovlr,rt.,(l.- 1gg0 - 2 aL
R
, 3. Have you or your spouse ever made a compromise settlement for violation of such laws? •
❑ YES , B NO
•
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)
BYES ❑ NO
5. Have you filed fingerprint cards and PROPER FEES (if check, made out to the NE State Patrol), with this application?
YES ❑ NO .
rLP ( P- c'0-, Nil- Y C ft9lP '10 D'Pv
LIST PRINCIPAL RESIDENCE FOR PAST 10 YEARS,APPLICANT AND SPOUSE MUST COMPLETE
APPLICANT:CITY&STATE YEAR SPOUSE:CITY&STATE YEAR
FROM TO FROM TO
0 (V 4 rf -a I 'i10 Zoo z G N Ps li Pr /4 a t7 117 a 2 a d 1
EMPLOYERS—LIST LAST TWO EMPLOYERS
YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER
FROM TO
19/e 2-a"L MC (2-L-E.:,e- (vc - ca S L,'- -S`16- yw_f-
PERSONAL OATH AND CONSENT OF INVESTIGATION—MUST BE SIGNED BY APPLICANT& SPOUSE
STATE OF NEBRASKA )
) SS
COUNTY OF )
e�1\\> -\ \--*'`h.>^
The above individual(s),being first duly sworn upomoath,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 arc 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.
/ .- -_.-----C—- -"`-- 2/.S----- e—--f
Signature of Applicant Signature of Spouse(if applicable) /�
Subscribed' y presence d swf to befog me this Subscribed' presence a s to bef me this d' `
day of .G O day of
giaz,
,/ /
ae...,(c2(4,
Notary Signature&Seale ntary Signature&Seal
GENERAL NOTARY-State of Nebraska? GENERAL NOTARY-State of Nebraska
j
MARYANN HANSEN FORDS 35-4013
ill MARYANN HANSEN .;;n, REV.8/01
. My Comm.E .May 24,2002 PAGE 2
My Comm.Exp.May 24,2002
• .
L-70:;,y
b ECE1VED
NEBRASKA LIQUOR CONTROL COMMISSION
AP� 11 2002
AFFIDAVIT OF NON PARTICIPATION
NEBRASKA LIQUOR
CONTROL COM I
The undersigned individual acknowledges that he/she will have no interest,directly or maire n
the operation or profit of the business, as prescribed in Section §53-125(13)of the Liquor Control
Act. Such individual shall not tend bar,make sales,serve patrons,stock shelves,write checks,sign
invoices,represent themselves as owner or in any way participate in the day to day operations in any
capacity. Undersigned will also be waived of filing fingerprint cards,however, has disclosed any
violation(s) on application. RECEIVED
APR 172002
Signature of Spouse
NEBRASKA LiQUOR
CONTROL COMMISSION
UBSCRIBED in my presence and sworn to before me this X day of
GENERAL NOTARY-State of Nebraska `,� � (� �� ��� ��
�f� MARYANN HANSEN -
gnature of Notary Public
s� My Comm.Exp.May 24,2002
The licensee/applicant understands that he/she is responsible for compliance with the conditions set
out above, and that if such terms are violated,the Commission may cancel or revoke the license.
/27 , Ic 7pe.,reci-
Signature of Licensee/Applicant Print Name of Licensee/Applicant
SUBSCRIBED in my presence and sworn to before me this P-- day of
,pZoob2 .
( GENETAR9RAL &AA/ at_aLti- 1
My Comm.Exp.MaY24,2002 Signattite of Notary Public
FORM 35-4178
REV 2/01
*printed on recycled paper
OMAHA, A,
City o Omaha Sfvlebras&a
�przow-vialt
1819 Farnam—Suite LC 1 'fly/Flairit
Omaha, Nebraska 68183-0112. 01, . "n
Buster Brown (402)444-5550 .o ti'
City Clerk FAX (402) 444-5263 O4'TED FEBR1-
April 29, 2002
Indian Restaurant &Associates Application to appoint Francis M. Mercer.
Dba"Indian Oven" manager of your present Class "I" Liquor
1010 Howard Street License
Omaha,NE 68102
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.
Sincerely yours,
Buster Brown
City Clerk
BJB:clj
• OMAHA, �,
City of Omaha, Webras&a
� r
1819 Farnam—Suite LC 1 z EftiI K `�t
Omaha, Nebraska 68183-0112 0�
Buster Brown (402) 444-5550 .o
City Clerk FAX (402) 444-5263 o'TED FEBR��I-
April 29, 2002
Francis Mercer • Application to be appointed manager of the
1106 Howard Street Class "I"Liquor Licenses for Inidan
Omaha,NE 68102 Restaurant&Assoc., dba"Indian Oven",
1010 Howard 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,
4L
Buster Brown
City Clerk
BJB:clj
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