RES 2022-1194 - Appoint Adam F Lowry manager of Longhorn Steakhouse 5422 111.
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t (')7.'1_4'i STATE OF NEBRASKA
c s Pete Ricketts NEBRASKA LIQUOR CONTROL COMMISSION
4 •�;�; .w_�,, Governor Hobert B.Rupe
� M btu_,� Executive Director
� q?CIf 301 Centennial Mall South
P.O.Box 95046
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: October 20, 2022
From: Rebecca Roberts (rebecca.roberts@nebraska.gov)
To: Omaha City Clerk
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: Rare Hospitality Management LLC
Trade Name (DBA): Longhorn Steakhouse 5422
License Number: 1-095406
Manager Name: Lowry, Adam F
Due Date: December 05, 2022
APPROVED
•
NO LOCAL RECOMMENDATION
❑ DENIED
COMMENTS: (YOU MAY ATTACH MINUTES AND/OR ADDITIONAL NOTES) •
Clerk's Name: j� U�Gedg
iz, Date: 12-14-2022
Kim Lowe Bruce Bailey Harry Hoch
Commissioner Chairman Commissioner
n Equal Opportunity Employer
V"1540Le
MANAGER APPLICATION office Use
INSERT- FORM 3c RECEIVED
NEBRASKA LIQUOR CONTROL COMMISSION
301 CENTENNIAL MALL SOUTH
PO BOX 95046 O C T 2 0 2022
LINCOLN.NE 68509-5046
PHONE:(402)471-2571 NEBRASKA LIQUOR
FAX:(402)471-2814 CONTROL COMMISSION
Website: www.kc.nebraska.eov
FORM MUST BE COMPLETELY FILLED OUT IN ORDER FOR APPLICATION TO BE
PROCESSED
MANAGER MUST:
Complete all sections of the application. Be sure it is signed by a member or corporate officers
corporate officer or member must be an individual on file with the Liquor Control Commission
tJFingerprints are required. See form 147 for further information,read form carefully to avoid delays
in processing, this form MUST be included with your application.
Provide a copy of one of the following: US 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 voter card or print document from
Secretary of State website with application
Spouse who will not participate in the business,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#1 of the application
Spouse who will participate in the business,the spouse must:
�• Sign the application
• Fingerprints are required. See form 147 for further information, read form carefully to avoid delays
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 voter card with application
• Spousal Affidavit of Non Participation Insert not required
60)4
1101 0 0 01 II 0 0
2200011977 Form 103
Ref July 2018
Page 1 of 6
MANAGER APPLICATION Office Use
INSERT- FORM 3c RECEIVED
NEBRASKA LIQUOR CONTROL COMMISSION
301 CENTENNIAL MALL SOUTH OCT 2 0 2022
PO BOX 95046
LINCOLN.NE 68509-5046 NEBRASKA LIQUOR
PHONE:(402)471-2571
FAX:(402)471-2814 CONTROL COMMISSION
Website:Www.1cc.nebraska.gav
MUST BE:
✓ 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 website
✓ 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
Coiporation/LLC information :». • .LI - r.
Name of Corporation/LLC: Rare Hospitality Management, LLC
•
Premise information .0
Liquor License Number: 95406 Class Type (if new application leave blank)
Premise Trade Name/DBA: LongHorn Steakhouse #5422
Premise Street Address: 7425 Dodge Street Suite 103
City:Omaha County: Douglas Zip Code:68114
Premise Phone Number:402-391 -2667
Premise Email address: Licensinglaw@darden.com
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.
�,vu/ULL_<71/��
SIGNATURE REQUIRED BY CORPORATE OFFICER/ MANAGING MEMBER
(Faxed signatures are acceptable)
Funs 103
Rev July 2018
Page 2of6
Manager's information must be completed below PLEAS-0 PRINT CLEARLY
Last Name: Lowry First Name:Adam MI: F.
Home Address: 1314 N 112th Plaza Apt. 2505 L .
City:Omaha County:Douglas zip Code:68154 '
Home Phone Number: 402/470-1775
Driver's License Number& State: .
Social Security Number:
Date Of Birth "` ` Place Of Birth:Omaha, NE
Email address:adamlowry1991@gmail.com
lAre.you marriedI£yes,completi. pouse"s infoima_6oa(Eve a spousal.af&davit has liven su .
❑YES •NO
Pouses'
Spouses Last Name: First Name: MI:
Social Security Number: /
Driver's License Number& State:
Date Of Birth: Place Of Birth:
APPLICANT&SPOUSE MUST;L'IS"T RESIDENCE(S) t TILE P. TEN(UD YEARS
APPLICANT _ RAM _
CITY& STATE YEAR YEAR CITY & STATE YEAR YEAR
FROM TO FROM TO
Omaha, NE 1991 2022
Form 10
Rey July 2018
Page 3 of 6
, _A_ - - •MANAGER'S LAST TWO^ LOXERS _ '
YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE
FROM TO NUMBER
2015 2016 Ozark Smoked Meat Company Ken McKeane 402/333-1744
2012 2015 Bag 'N Save Bill Johnson 402/493-8800
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 is a party to this application, or their spouse.EVER 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 law,
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 violations. 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 0 NO
If yes,please explain below or attach a separate page.
Date of Where Description
Name of Applicant Conviction Convicted of Disposition
(mm/yyyy) (City& State) Charge
•
2. Have you or your spouse ever been approved or made application for a liquor license in Nebraska or
any other state?
OYES ONO
IF YES, list the name of the premise(s):
3. Do you, as a manager, qualify under Nebraska Liquor Control Act (.53-131.01)and do you intend to
supervise, in person, the management of the business?
OYES ONO
Form 103
Ito July 2018
Paec 4 ot'6
4. List the alcohol related training and!or experience(when and where)of the person makine application.
*NLCC Training Certificate Issued: Name on Certificate:
Date
Applicant Name Name of program(attach copy of course completion
(nu/yyyy) certificate)
Adam Lowry 01/2022 Responsible Alcohol Service
•
*For list of NLC'C Certified Training Programs see training
Experience:
Applicant Name/Job Title Date of Name& Location of Business:
Employment:
Adam Lowry/Manager 01/2022-Present Long Horn Steakhouse #5422 - Omaha, NE
5. Have you enclosed form 147 regarding fingerprints?
DYES ONO
Fonn 10.
Rev July 2018
Page 5 of 6
PERSONAL OATH.A"ND_COiir tic Tr£y:IlVVESTIGATION _ _ -
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 t$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 be used to check the criminal history
records of the FBI. You have the opportunity to complete or challenge the accuracy of the information
contained in FBI identification record. The procedures for obtaining a change, correction, or updating an
FBI identification record are set,forth in Title 28, CFR, 16.34.
ill 11-
Signature of N anager App leant Signature of Spouse
r
ACKNOW LEDGEMENT
State of Nebraska
County of pC i; The foregoing instrument was acknowledged before me this
1O i ict 12022 by cA,w'^— LCw
da,e NAME OF PERSOONEING ACKNOWLEDGED
•
Affix Seal
• o ary Public sign lure XNERALNOTARY-StateofNebraska
ALEXA HERRINGTON
My Comm.Exp.February 10,2025
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.
Fom 103
Rev July 2018
Page 6 of 6
PRIVACY ACT STATEMENT/
SUBMISSION OF FINGERPRINTS / RECEIVED
PAYMENT OF FEES TO NSP-CID
NEBRASKA LIQUOR CONTROL COMMISSION OCT 2 0 2022
301 CENTENNIAL MALL SOUTH.
PO BOX 95046 NEBRASKA, LIQUOR
LINCOLN,NE 68509-5046 CONTROL COMMISSION
PHONE:(402)471-2571
FAX: (402)471-2814
Website: www.lcc.nebraska.gov
THIS FORM IS REQUIRED TO BE SIGNED BY EACH PERSON BEING FINGERPRINTED:
DIRECTIONS FOR SUBMITTING FINGERPRINTS AND FEE PAYMENTS:
• FAILURE TO FILE FINGERPRINT CARDS AND PAY THE REQUIRED FEE TO THE
NEBRASKA STATE PATROL WILL DELAY THE ISSUANCE OF YOUR LIQUOR LICENSE
• Fee payment of 545.25 per person MUST be made DIRECTLY to the Nebraska State Patrol:
It is recommended to make payment through the NSP PayPort online system at www.ne.gov/Qoinsp
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
• Fingerprints taken at NSP LIVESCAN locations will be forwarded to NSP—CID
Applicant(.$) will not have cards to include 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 Challenge: Your fingerprints will be used to check the criminal history
records o/'the FBI. You have the opportunity to complete or challenge the accuracy of the information
contained in the FBI identification record. The procedures for obtaining a change, correction, or updating
a FBI identification record are set forth in Title 28, CFR, 16.34.
•
****Please Submit this form with your completed application to the Liquor Control Commission****
Trade Name Longhorn Steakhouse#5422
Name of Person Being Fingerprinted: Adam F. Lowry
Date of Birth: — Last 4 S N:
Date fingerprints were taken: 0 / - /?CZ ?.
Location where fingerprints were taken: State Patrol Office:4411 S. 108th Street Omaha, NE 68137
How was payment made to NSP?
NSP PAYPORT ❑CASH ❑CHECK SENT TO NSP CK#
My fingerprints are already on file with the commission — fingerprints completed for a previous
applicati le than years ago? YES ❑
SIGNATURE REQUIRED OF PERSON BEING FINGERPRINTED
FORM 147
REV JUNE 2021