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RES 2002-0475 - Appoint James W Crawford manager of Omaha Marriott Hotel ti STATE OF NEBRASK4CEIVE [J --tv sT:r„ NEBRASKA LIQUOR CONTROL COMMISSION 0°' 02 FEB 13 �M 8: 47 Forrest D. Chapman z„, _ Executive Director "joa : ►74 1, 1 301 Centennial Mall South,5th Floor ,�w,�� ,�fi, � P.O.Box 95046 ;�o.:y• ` m;- CITY CLERK Lincoln,Nebraska 68509 5046 '�; '�'d'Ilii r • • ,,4:---f➢!-$ {^,`q. Phone(402)471 2571 0- 4 1 1 A N A, NEBRASKA Fax(402)471-2814 TRS USER 800 833-7352(TTY) Mike Johanns Governor • February 11, 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 LaSalle Hotel Lessee Inc located at Omaha Marriott Hotel, 10220 Regency Circle, Omaha, NE 68114 (Douglas County) which holds a Class C license #40597 the applicant's name is James W. Crawford. • 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, M chelle Petersen • Licensing Division Enclosure . Rhonda R. Flower Bob Logsdon R.L. (Dick)Coyne Commissioner Chairman Commissioner An Equal Opportunity/Affirmatiue Action Employer Printed with soy ink on recycled paper Application for Corporate Manager '= *Must Be A Nebraska Resi t i - LID-) AN " 9 2002 Please submit in Triplica J Return to: Nebraska Liquor Control Commission,PO Box 95046 EBRASKO LIQUOR CONTROL COMMISSION 301 Centennial Mall So.,Lincoln NE 68509 , Phone: (402)471-2571 Fax:(402)471-2814 Web address: http://www.nol.org/bome/NLCC/ LIQUOR LICENSE INFORMATION NAME OF LICENSED CORPORATION • CLASS&LICENSE NUMBER Lez r L—ici-SA,LLF C-1-0-k-ni L..E- cr b &611 TRADE NAME OF LICENSED PREMISE d'MAA ' V`APPP-0..lcrIc N-v'triL STREET ADDRESS OF LICENSED PREMISE CITY COUNTY ZIP CODE lO -2v v..NC , GU.-CLrt m. aA-hl,/!- ' _ D'0%AI A-$L. . . (51 o (l q. . On behatf of the corporation,I desi ate this individual as corporate manager. ' n t + 1 :rat resident/CEO: . . . APPLICANT INFORMATION(MUST BE 21 OR OVER) NAME(LAST,FIRST,MIDDLE,MAIDEN) SEX SOCIAL SECURITY NUMBER DATE OF BIIRTH PLACE OF BIRTH CID y C(LP)I.JF0,R b)Zt,,rt izs `f-1'�Fc.�(L F 3 I z g/t96 s` . Li A- v HOME STREET ADDRESS CITY COUNTY STATE ZIP CODE • tox Z-i 042•Ne .s'tc�.NCs pl-A- - o v w\-A. Do.,.% /N--5 MR (s &( 3`/ HOME TELEPHONE NUMBER BUSINESS TELEPHONE NUMBER DRIVERS LICENSE NUMBER&STATE ('{02) 5 ? 1 --((8'{5 ('-l 'Z- 5L(o -3t91O ti1269`i(ag°1 \\\e62..4-A SPOUSE'S INFORMATION(IF NOT MARRIED INDICATE) , FULL NM A LAST,FIRST,MIDDLE,MAIDEN) SOCIAL SECURITY NUMBER DRIVERS LICENSE NUMBER vtOn� , &STATE Pt' 10tEe� Ito 1 J Anclet ivtarl� ,_ if l„) . 'j 3 11). DATE OF BIRTH: ""2 CpPLACE OF BIRTH $- J O.S L'� H — /)fi,t. i . 1. READ CAREFULLY. Answer completely and accurately. i" 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. ❑Yes leo • 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. DYES *NO FORM 35-4013 • REV 2/01 PAGE 1 3. Have you or your spouse ever made a compromise settlement for violation of such laws? OYES WNO 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) RYES ONO 5. Have you filed fingerprint cards and PROPER FEES(if check,make out to the NE tate Patrol),with this application? y�� At G YES ONO (,� "` SenT L 1 V Potkro0/I re_c TPI '. 1 `1 �' t t saes � oe It 444$4, APPLICANT:CITY&STATE YEAR SPOUSE:CITY&STATE YEAR l9'54tq- Iry cis FROM TO �/►��'�.1�•C'1 "ton., 4l(a- `j7. .1 ZTI1T�A VYUSScIAA-D-c • � CS2Y cssd...I - 9 7 `d g Q^M-k i rM-sty . O DZ C,d►Y^Drx,u-tvvti Jv\ SSouJ2-t 61 ?7 © r&J\ 1\131,4 at- get 2 YEARO NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE NUMBER FROM TO 2- p P 1-4-koTC bk-<<-T Lep2.-3`t9--16 /9 ��1 d�- pevaa-o-c71t 1M.A - Fivlart.y css-1-2-3 -6-tcb STATE OF NEBRASKA ) ,`; j SS COUNTY OF69660a . 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°faction that said applcani'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. Sig azure of Applican 'gtwture of (if applicable) Subscrib d in my presence and sworn to ore me this 7 Subscrib in my presence and sworn to before me this ✓'7 day of t c 1 oZ 00a day of �oG�(zc/ if:ed C d).-e- X.tO1!/- otary Signature&Se , Notary Signatures Seal <01.Qt`%. DIANE J.GEISSINGER a °`"`""` .= MY COMMISSION EXPIRES ssF•, DIANE J.GEISSINGER 4"—`";` - 3t45 ul _ MY COMMISSION EXPIRES ., m" April 11,2005• FORM 35 4013 '�, "MAf1YS -w�P• April 11,2005 REV"2i01 _ _ ,"HAS,.• — PAGE 2 -,JAN: 7. 20021112: 39PNGAM (*OMAHA MARRIOTTL NO. 9249 P. 3 C 0 FY NEBRASKA LIQUOR CONTROL COMMISSION AFFIDAVIT OF NON PARTICIPATION 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 1153-125(13)of the Liquor Control Act. Such individual shall not tend bar,make sales,save patrons,stock shelves,write checks,sign invoices,represent themselves as owner or in any wayparticipate inthe day to day operations in any capacity. Undersigned will also be waived of filing fingerprint cards,however,has disclosed any violation(s)on application. Si a of Spouse SUBSCRIBED in my . rJ and sworn to before me this / ‘166 day of , DCA .. DIANE d GEISSINGER /04.4;4%.e..„MY COMMISSION EXPIRES April».2QO5 Signs f Notary Public • The licensee/applicant understands that he/she is responsible for compliance with the conditions set *at above,and that if such terms are violated,the Commission may cancel or revoke the license. • i c3 Signature of Licensee/Applicant Print Name of Licensee/Applicant SUBSCRIBED in my presence and sworn to before me this 7 day of e9rgazdz,,gzIL , DfANE J.GEISSIN(�R S.igaature of otary Public m'pISS(ONEXPIRE8 ApIN 11,Z005__ J FORM 354178 REV 2/01 • il: r • • CrC 00 PP P . . cn C CAD N UQ .. O CD o O x x rn 6- C7 '"� ° O o ri CD O O •�p• P l �` ,--, LN \ � '0 CD r • o CD N cra 5 r, (O n N .1 G. cn P