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RES 2002-0768 - Appoint Andrew J Fenton manager of Godfather's Pizza #28028 :STATE OF NEBRAS • lzaE NEBRASKA LIQUOR CONTROL COMMISSION 02 P RN R 12 1111 o: 2 7 Forrest D. Chapman O Executive Director ,��, %It 301 Centennial Mall South,5th Floor .�$�'+ /�;i • _ • P.O. Box 95046 �1'�' "+=' CITY CLERK Lincoln,Nebraska 68509-5046 �; 'Cdi a� 1. Phone(402)471-2571 aRaAj°=° CM�H�� N�f3iJ �a. Fax(402)471-2814 TRS USER 800 833-7352(TTY) Mike Johanns • Governor March 11, 2002 City Clerk Omaha/Douglas Civic Center 1819 Farnam LC-1 Omaha NE 68183 • RE: Manager Applications Submittal Dear Sir/Madam: The enclosed Applications for Manager applicant Andrew Fenton are being submitted by Godfather's Pizza Inc DBA Godfather's Pizza located at these locations: -it 2855 South 168th Street, Omaha,NE 68130 (Douglas County) Class A License#47293 12275 West Center Road, Omaha,NE 68144 (Douglas County) Class A License#35921 • • 11345 Davenport Street, Omaha,NE 68114 (Douglas County) Class A License#28790 4727 South 24th Street, Omaha,NE 68105 (Douglas County) Class A License#21101 5010 Grover Street, Omaha,NE 68106 (Douglas County) Class A License#28620 7515 Pacific Street,Omaha,NE 68124(Douglas County) Class J License#16436 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, • • helle 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 � , /Application for Corporate Manager *Must Be A Nebraska Resid nt* r ' - • Please submit in Triplic Return to: Nebraska Liquor Control Commission,PO Box 95046 op TE13 2 2 200 301 Centennial Mall So.,Lincoln NE 68509 Phone: (402)471-2571 Fax: (402)471-2814 Web address: http://www.nol.org/home/NLCC/ NEBRASKA Ll 'u" . ' TROL GOTA1 ' .( LIQUOR LICENSE INFORMATION NAME OF LICENSED CORPORATION CLASS&LICENSE NUMBER Godfather's Pizza, Inc. Class A 47293 TRADE NAME OF LICENSED PREMISE Godfather's Pizza (#28028) STREET ADDRESS OF LICENSED PREMISE CITY COUNTY ZIP CODE 2855 South 168th Street Omaha Douglas 68130 On behalf of the corporation.I designate this individual as corporate manager. 1 Signature of Corporate President/CEO: /,0 0 1 APPLICANT INFORMAT N (MUST BE 21 OR OVER) NAME(LAST,FIRST,MIDDLE,MAIDEN) SEX SOCIAL SECURITY NUMBER DATE OF BIRTH PLACE OF BIRTH F M Fenton, Andrew, Joseph 5/24/60 Rice Lake, WI — HOME STREET ADDRESS CITY COUNTY STATE ZIP CODE 14812 Ridgeview Drive Plattsmouth Cass NE 68048 HOME TELEPHONE NUMBER BUSINESS TELEPHONE NUMBER DRIVERS LICENSE NUMBER&STATE ( 402) 296-2527 (402 ) 391-1452 G20012754 hi, p 1 , 0,� SPOUSE'S INFORMATION (IF NOT MARRIED INDICATE NONE) FULL NAME(LAST,FIRST,MIDDLE,MAIDEN) I SOCIAL SECURITY NUMBER DRIVERS LICENSE NUMBER Fenton Cynthia .Ann (Konkler) &STATE G20016000 DATE OF BIRTH: 02/09/1961 PLACE OF BIRTH: Omaha, NE 1. 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 pending at the time of this application. If more than one party,please list charges by each individual's name. E YES axNO 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. ❑ YES NO !.-, J.;.: ,-t,27 .•4. •f i.:.'?_'1-..t.At-. .•1A3 4 RN1 35-4013 REV.8/01 • ' .,j _ tiY ,....a......l PAGE I Mar, 8. 2002 4: 24PM GODFATHERS PIZZA, INC, No, 7933 P. 2/2 3. Have you or your spouse ever made a compromise settlement for violation of such laws? • ❑ YES =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(f53-131.01) l YES ❑ NO 5. Have you filed fingerprint cards and PROPER FEES(if check.made out to the NE State Patrol),with this application? ❑ YES XIY NO LIST PRINCIPAL RESIDENCE FOR PAST 10 YEARS,APPLICANT AND SPOUSE MUST COMPLETE ,APPLICANT:CITY&STATE YEAR SPOUSE:CITY St STATE YEAR FROM TO FROM TO 1007 C1inccn St. Platt cittrh. NE 198E 1991 same _ 14812 Ridgeview Dr. Plactsmouth, 1993 Present same SE I EMPLOYERS—LIST LAST TWO EMPLOYERS • YEAR NAME OF EMPLOYER t NAME OF SUPERVISOR TELEPHONE NCMIBER FROM TO 09/24101 Present Godfather's Pizza, Inc. Bruce Cannon 402-391-1452 4/1984 09/20/0:11cDonalds Bob Edwards 402-733-9400 PERSONAL OATH AND CONSENT OF INVESTIGATION—MUST BE SIGNED BY APPLICANT&SPOUSE STATE OF NEBRASKA ) COUNTY OF ) 1 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 tending 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 a(didavit may be attached however:range rprint cards are sn71 uired"tO1e Med. The undersigned understand and acknowledge that any license issued. based on the ation submitted in this application. it-subject to cancellation if the information contained herein is incomplete and inaccurate. t13z/LC..•....." .� -P't ts..---• (?yrirt„,k;.se..0 --(-7\'1-"Q.1'70:0-1-----' Signature of Applicant Signature of Spouse(if applicable, Subscribed in my presence and sworn to before me this,\\ Subscribed in my presence and sworn to before me this U day of er.b^ • dCi Oa'of C >� ZOO7— . milfidgl — /ronry Si cure at Seal Ow commIss &sea' WIRES GENERAL NOTARY-Slate of Nebraska Jtery EOR�I ?•1ii' i7,20D5 K}` ,(rt SANDRA J.MEYER —�y Rilig COcCEVED FEB 22 2002 NEBRASKA LIQUOR CONTROL COMMISSION NEBRAS �IUv` AFFIDAVIT OF NON PARTICIPATION CONTROL COMM, IUN � The undersigned individual acknowledges that he/she will have no interest,directly or indirectly,in 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. Siature of Spouse SUBSCRIBED in my presence and sworn to before me this \\ day of A GENERAL NOTARY-State of Nebraska ji / (//i/iSANDRA J.MEYER My Comm.Exp. Oct.1,QOc) Signature o otary Public 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. %t.tel; c✓ cc'I74.04 Signature of Licensee/Applicant Print Name of Licensee/Applicant SUBSCRIBED in my presence and sworn to before me this /51 day of /g/2u /9gy , .000A . = GENERAL NOTARY-State of Nebraska VIVIAN HOMOLKA Signature of Notary Public • My Comm.Exp.Feb.14,2005 FORM 35-4178 REV 2/01 • City of Omaha ST'slebraskg `.3. 1819 Farnam—Suite LC 1 2 I1 (lfr ii1 � Omaha, Nebraska 68183-0112 0 ".-�-g., , ;.._. Buster Brown (402) 444-5550 �A 1 City Clerk FAX (402) 444-5263 O�'T�p FEBR°I- March 12, 2002 Godfather's Pizza, Inc. Application to appoint Andrew J. Fenton Dba"Godfather's Pizza#28028" manager of your present On Sale Beer 2855 South 168th Street License Omaha, NE 68130 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 March 26, 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. Sincerelyyours, / Buster Brown City Clerk BJB:clj 0 4-3-----4:: ) 4 -44 . CD / 0 L \ g 00 K ,t q m ] § m ? $ 0 IQ 21 k \ 8. ° - m ® En .� q r ~ ® & o 00 1-0 k' ° ) . _ p 7 , 0 00 / o k ƒ U _ q Cr? \ K & Nii co Pn � . 0 ` c a 0 � n � / ) § ƒ . . R \ f / I { . �