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RES 2023-0077 - Appoint Paul H Bohannon Jr manager of Bagdad Lounge E-MAILED TO NLCC /-.25-Z3 c, sTAr;y,'. y~' ? a • STATE OF NEBRASKA "1',; Pete Ricketts NEBRASKA LIQUOR CONTROL COMMISSION • �` `f ';I Governor Hobert B.Rupe to ���. { = Executive Director k ii r^-' 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: `December 2-a", -2022 From: •Rebecca Roberts (rebecca.roberts@nebraska.gov) To: OrliaflaaCit .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: Tangier Temple Holding Corp t 4i ..- Teade Name(DBA),: Bagdad Lounge License Number: C-004320 Manager Name: `B,oh'arinon, Paul H Jr Due Date: February pp 2023 y APPROVED NO LOCAL RECOMMENDATION. El DENIED c'b .. rr*caR,s +y. , COMMENTS: (YOU MAY ATTACH MINUTES AND/OR ADDITIONAL NOTES) • • Clerk's Name: - Date: ) Z J - 76Z 3 Kim Lowe Bruce Bailey Harry Hoch Commissioner Chairman Commissioner An Equal Opportunity Employer 3Ziee t2a23 — 1)(fl :4 0 it-7 y ,-2-c'2-3 -3 © MANAGER APPLICATION Office Use INSERT-FORM 3c RECEIVED NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH Ptr; 2 :1 2022 PO BOX 95046 LINCOLN,NE 68509-5046 � ;I�l� PHONE:(402)471-2571 FAX:(402)471.2814 CONTROL i`Vrt:. iS.~SIGN Website:www.lcc.nebraska.gov FORM MUST BE COMPLETELY FILLED OUT IN ORDER FOR APPLICATION TO BE PROCESSED MAIyAGER MUST: 'V Complete all sections of the application. Be sure it is signed by a member or corporate officer, corporate officer or member must be an individual on file with the Liquor Control Commission 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: US birth certificate,naturalization papers or current US passport(even if you have provided this before) v4 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 ac15 Tr our uei Spouse who will not participate in the iblusiness,spouse must: • Complete the Spousal Affidavit of Non Participation Insert(must be notarized), The non- ,, v0 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 41 of the application Spouse who will participate in the business,the spouse must: • Sign the application • Fingerprints- p are required. See form 147 for further information, read form carefully to avoid delays q 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 2200013736 � © � y, Form 103 Rev July 2018 Page 1 of 6 MANAGER APPLICATION Office Use INSERT-FORM 3c RECEIVED NEBRASKA LIQUOR CONTROL COMMISSION DEC 3 ZGi'1 301 CENTENNIAL MALL SOUTH PO BOX 95046 LINCOLN,NE 68509-5046 NEBR/ )'.i+JR PHONE:(402)471-2571 FAX:(402)471-2814 Website:www.lcc.nebraska.gov 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 1 21 years of age or older CorporaatipeeL,C information Name of Corporation/LLC: �o. r\ 9 r e r -7`e d i e mom,. y, Core, Pi+0I111�4:1t1fOLiiIBtUOII . . Liquor License Number: 0 0 1/3 oA 0 Class Type C (if new application leave blank) Premise Trade Name/DBA: Bo,5 d L O U,je Premise Street Address: .2 ).3 So VIA 9. 99141 cert City: Q rrl ctLa County: OCali /45 Zip Code: + 1 2 Premise Phone Number: l 01-— 3 12 OLfq Premise Email address: -1''auk 3 -NA�g '1 e r c t r i 012. , CG1 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. Z. 0 SIGNATURE REQUIRED BY CORPO TE OFFICER/MANAGING MEMBER (Faxed signatures are acceptable) Form 103 Rev July 2018 Page 2 of 6 Manager's information must be completed below PLEASE PRINT CLEARLY Last Name: .19 o Q q A i1 t2 .n " First Name: Pau1 l MI: t"r' c Home Address: 1 2 14/ -] � IC;ti v\ City: 0 in u Ia County: ,OLD zip Code: ' F133 Home Phone Number: VD — q 4 `d� Cl Driver's License Number&State: Social Security Number:Date Of Birth: Place Of Birth: H()fro ,,//a� �a riS Rs Email address: fi Q U 1 /30 5 2 ( COX_ Are you m cried?If yes,complete spouse's information(Even if a spousal affidavit has beets submitEed)� Q YES ZNO Spouse's information _ Spouses Last Name: First Name: MI: Social Security Number: Driver's License Number& State: Date Of Birth: Place Of Birth: 'APPLICANT&SPOUSE MUST LIST RESIDENCE(S)FOR THE PAST TEN(10)YEARS APPLICANT SPOUSE CITY& STATE YEAR 'YEAR CITY&STATE M YEAR Lok krb 5,6 /\fe r. )9%3 tuire4 Form 103 Rev July 2018 Page 3 of 6 ~ I MANAGER'S LAST TWO E LUYERS YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE FROM TO NUMBER 31,26 Ja 31�?D'7 S !r m )�y4 ��e pu� , n lia 2- 671-obgib � P i riot 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 d 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? DYES 1 NO IF YES,list the name of the premise(s): 3. Do you, as a manager, qualify under Nebraska Liquor Control Act($53-13 1.01) and do you intend to supervise, in person,the management of the business? IYES ❑NO Form 103 Rev July 2018 Page 4 of 6 List the alcohol related training and/or experience(when and where)of the person making application. *NLCC Training Certificate Issued: Nc iF Name on Certificate: Applicant Name (mom tyyyY) Name of program(attach copy of course completion certificate) *For list of NLCC Certified Training Programs see training Experience: Applicant Name/Job Title Date of Name&Location of Business: �A Employment: Noide 5. Have you enclosed form 147 regarding fingerprints? OYES ONO Form 103 Rev July 2018 Page 5 of 6 ���PER54N�L�O'ATR� ID�C4NSENT,�O-F,,�II�ESTTGA►�iaN���� 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 453-131.01)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 ident f cation record are set forth in Title 28, CFR, 16.34. PcLu) NA. Signature of Manager APPlicatt Signature of Spouse ACKNOWLEDGEMENT t State of,Nebraska County of iJ t 4 L4C% The foregoing instru lent was acknowledged before ine this ! ` 40 'dat� U c- Cf by PC7‘Ct 11 AO/14 110 NAME OF PERSON BEING`ACKNOWLEDGED tr'''�"`- / .c4 Affix Seal Notary Public ign� j GENERAL NOTARY-State of Nebraska BRIAN I SKOGERBOE My Comm.Exp.January 10,2023 .e 11n. 7ctititi e> 333_ 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. Form 103 Rev July 2018 Page 6 of 6 PRIVACY ACT STATEMENT/ SUBMISSION OF FINGERPRINTS / RECEIVr:' PAYMENT OF FEES TO NSP-CID NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH ""='~ PO BOX 95046 •-. LINCOLN,NE 68509-5046 ;,, . ,• . • PHONE: (402)471-2571 FAX: (402)471-2814 Website: www.Ice.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$45.25 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/go/nsp 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(s) 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 of 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 Name of Person Bein Fine rinted: _/o�� Q ©k a A n o n 5 r. Date of Birth: Last 4 SSN: MUM Date fingerprints were taken: $/ 1/ l ke 22 Location where fingerprints were taken: /45 P 10 s c 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 application less than 2 years ago? YES ❑ PGII % - - SIGNATUREREQUIRED OF PERSON BEING FINGERPRINTED FORM 147 REV JUNE 2021 12/23/22,3:12 PM Enterprise Mail-MANAGER'S APPLICATION FOR OMAHA CITY COUNCIL HEARING-TANGIER TEMPLE a� t�nl' Carman Johnson (CCIk) <carman.johnson@cityofomaha.org> MANAGER'S APPLICATION FOR OMAHA CITY COUNCIL HEARING - TANGIER TEMPLE 1 message Carman Johnson (CCIk) Fri, Dec 23, 2022 at 3:12 <Carman.Johnson@cityofomaha.org> PM To: "paulbo52@cox.net" <paulbo52@cox.net>, TANGIER@tangiershrine.com Bcc: "Elizabeth Butler (CCIk)" <elizabeth.butler@cityofomaha.org>, "Kimberly Hoesing (CCIk)" <kmberly.pulliam@cityofomaha.org> Good late day RE: TANGIER TEMPLE HOLDING CORP The Omaha City Clerk's Office has received your application from the Nebraska Liquor Control Commission. The Omaha City Council will hold a public hearing on this request on Tuesday, JANUARY 24, 2023. City Council meetings start at 2:00 PM and are located in the Legislative Chambers in the Omaha/Douglas County Building located at 1819 Farnam Street, Omaha, NE 68183. You or a representative is required to attend the meeting. I ALSO NEED THE DATE OF BIRTH FOR PAUL H. BOHANNON, JR. PLEASE SEND ME THIS INFORMATION AS SOON AS POSSIBLE. Please notify me if you have any questions. - Thanks Carman Johnson Liquor Clerk City of Omaha/City Clerk 1819 Farnam Street Suite LC-1 Omaha, NE 68183 402-444-5324 402-444-5263 fax Carman.johnson@cityofomaha.org hops://mail.google.com/mai I/u/0/?ik=cd387c45eb&view=pt&search=all&permthid=thread-a%3Ar8062803122754353388%7Cmsg-a%3Ar89594675230... 1/2