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RES 2023-1011 - Appoint Jason R Nagle manager of Elkhorn Fraternal Order of Eagles #3943 A • ' STATE OF NEBRASKA t, ; Jim Pillen NEBRASKA LIQUOR CONTROL COMMISSION ,,4if Governor Hobert B.Rupe Executive Director 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(TrY) Web Address https://www.lcc.nebraska.gov Today's Date: September 19, 2023 From: Ashley Martin (Ashley.Martin@Nebraska.Gov) To: City Clerk of Omaha 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: Elkhorn Fraternal Order of Eagles#3943 Trade Name (DBA): Elkhorn Fraternal Order of Eagles#3943 License Number: 78297 Manager Name: Jason R. Nagle Due Date: November 03, 2023 n APPROVED NO LOCAL RECOMMENDATION n DENIED COMMENTS: (YOU MAY ATTACH MINUTES AND/OR ADDITIONAL NOTES) #29 RES #2023-1011 OCTOBER 17, 2023 a6 54d2A, OCTOBER 18, 2023 Clerk's Name: Date: Kim Lowe Bruce Bailey Harry Hoch Commissioner Chairman Commissioner An Equal Opportunity Employer 1 MANAGER APPLICATION FORM 103 : . RECEIVED 711 . . NEBRASKA LIQUOR CONTROL COMMISSION License 301 CENTENNIAL MALL SOUTH Clan: C SEP 12 2023 PO BOX 95046 LINCOLN,NE 68509-5046 - PHONE:(402)471-2571 License Number: limo NEBRASKA LIQUOR FAX:(402)471-2814 EMAIL:Icc.frontdcckL,nebraska.8o�` CONTROL COMMISSION WEBSITE:www.icc.ncbraska.gov 1 gd�g1 ', MANAGER MUST: • Be at least 21-years of age • Complete all sections of the application. • Form must be signed by a member or corporate officer • Include Form 147-Fingerprints are required • Provide a copy of one of the following:US birth certificate,US Passport,naturalization papers OR legal resident documentation • Be a resident of the state of Nebraska and if an US citizen be a registered voter in the State of Nebraska • Spouse who will participate in the business,the nouse must meet the same requirements as the manager applicant: Spouse who will not participate in the business • Complete the Spousal Affidavit of Non Participation(Form 116). Be sure to complete both halves of this form. CORPORATION/LLC INFORMATION _ _ _ '_ _-' _— _ . ___ _._ _ • .. t t Name of Corporation/LLC: �,` R,., ;c:-�i=(2.NAt 0e 2 oo E.,A41 -i* 39 413 PREMISES INFORMATION _'_ _-4,______�___ __ Premises Trade Name/DBA: \W,,0).0 zA- e.wA1, ( .tx:a,, of- files_ 39 y 3 Premises Street Address: , Qa-r(,, k.Oin--- 4-. c).O• ',lox (0133 City: GE Ik1,01-i.,->- - - County: Q%AStA5 Zip Code: 6S0.32Z-(.33 Premises Phone Number: A= - -1SS1 - - ' Premises Email address: FOE 39143 () 1M5 .'ram. SIGNA REQLITi►D BY CORPORATE OFFICER/MANAGING MEMBER The in ividual whose name is listed as a corporate officer or managing member as reported or listed with the Commission. 2300008695 . FORM 103 REV 12/8/2022 PAGE 1 MANAGER INFORMATION • Last Name: t\ First Name: J 1.1 Home Address: (2O City: f k t&l.o RP A 5 Zip Code: 6AsvZZ Home Phone Number: Hui Email address: �� a 1 GA OD l oe .Can& . Are you married?If yes,complete spouse' if s sPaussl affic' V t bag:heal sobmitbed) ©YES a"NO Spouse- 'a information V Spouses Last Name: - First Name: MI: Social Security Number: Driver's License Number: Date of Birth: :Etace;of Huth: APPLICANT&SPOUSE MUST LYST kESIDENCE(3)FORTUE PAST TEN(1Q)YEAttS APPLICANT SPOUSE YEAR YEAR ,, . YEAR YEAR CITY &STATE CITY&STATE FROM TO FROM TO \k‘e,,r,..N 1 J6 r315 4/00 4/1 ci FORM 103 REV 1218/2022 PAGE 2 MANAGER'S LAST TWO EMPLOYERS YEAR PHO TELEPHONE FROM TO NAME OF EMPLOYER NAME OF SUPERVISOR NUMBER L-112..z er d-or.s t)AA jjC--3an»tb 4101 :Sat ciobS' , 'ra, 1 1-As EAck itRNsG5 C3°' w>vAs you ,W1 53�� 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 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 ❑ 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&• Charge State) �A50N t..\AS\E 1k/ot/adz w,okk- , � •o'{ viow... cot_ 5u,se 1 yQ ..JJ77 51 13 17� 1we CCM" koss of GaL • 2. Have you or your spouse ever been approved or made application for a liquor license in Nebraska or any other state? DYES 12'"O 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? RirES ONO FORM 103 REV 12/8/2022 PAGE 3 4. List the alcohol related training and/or experience(when and where)of the person making application. DateAP Applicant Name Name of program(attach copyof course com letion (�YYYY) n certificate) _ ASoa 11/43Pr51i' Gg t ao?3 R= vki): Ctre E ti5 ego;c TPA 0-5 *For list ofNLCC Certified Training Programs see training Experience: Applicant Name/Job Title Date of Name&Location of Business: Employment:- - - � Z 1J �1- Tiucs4ers _�S�o?o c; ��t'1�.e�N t at i t Ocuk:r� of €asIES 4 3'1'L 'bAdeN, c7ogn, 4£0)72_-433 • 5. Have you enclosed Form 147 regarding fingerprints? i ES ENO • FORM 103 REV 12/8/2022 PAGE 4 ., N 410r .. . 0'\-31 01. ci < 0 , ..- "0 . • e. tit ,, • r W 8C) < �% V S will 71(3 `T �Q� co • L,' 1141 O � L w N .Q .1. �' 0 C € • l� v h..._ W CL -8 w •123 0 , • •,,,,,v.-.... .) .E.% .§ -a 73 . .v(-1 , k. 16. :6'. 71 . i ‘.,./) kid C.) a„ N �I Z ' 9 . :vi 1 c..,) v.•:..•AN 41k11( .iKi i VS C I m ce x . (` • (;r f; • PERSONAL OATH AND CONSENT OF IN T VES ICATIO SIGNATURE PAGE—PLEASE READ CAREFULLY The undersigned applicant(s)hereby consent(s) to an investigation of hisiher background and release present and future records of every kind and description including police records, tax records (State and Federal), and bank or lending institution records, and said.applicant(s).and spouse(s).waive(s) any.right or causes of action that said applicant(s) or spouse(s)may have against the Nebraska LiquorControl Commission,the Nebraska State Patrol,and any other individual disclosing or releasing said information. Any documents or records for the proposed business or for any partner or stockholder that are needed in furtherance of the application investigation of any other investigation shall be supplied immediately upon demand to the Nebraska Liquor Control Commission or the Nebraska State Patrol. The undersigned understand and acknowledge that any license issued.based on the informationsubmitted in this application.is subject to cancellation if the.information contained herein is incomplete.inaccurate or fraudulent. Applicant Notification and Record Challenges 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 2a.CFR, 16.34. Must be signed by applicant and spouse. ,r„ f2jf� Signre ofdt.PPLICANT -Signature of SPOUSE �J/_ #.SC��cJ iZ 4U/R qJL Printed Name of APPLICANT Printed Name of$POpSE FORM 103 REV 12/8/2022 PAGE 5 PRIVACY ACT STATEMENT/ • SUBMISSION OF FINGERPRINTS/ RECEIVED PAYMENT OF FEES TO NSP-CID NEBRASKA LIQUOR CONTROL COMMISSION SEP 2 Z323 301 CENTENNIAL MALL SOUTH PO BOX 95046 NEBRASKA`LIQUOR LINCOLN,NE 68509-5046 . CONTROL COMMISSION PHONE: (402)471-2571 FAX: (402)471-2814 \Vebsite: wOAW.1cc.nebraska_go • THIS FORM ISREOUiRED 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 ISSI(JANCE 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 flkl,ocw c04.A•gaj.1 g 0eico.' t'-rgigs -'"`3943 Name of Person Being Finge rinted: ,.S 4s,s0►s 9. N IF Date fingerprints were taken: al/3o)a3. Location where fingerprints were taken: ovn ItaA Soy 6 ►sue 54. How was payment made to NSP? ❑NSP PAYPORT ❑CASH.'CHECK SENT TO NSP CK# Go r le, My fingerprints are already on file with the commission—fingerprints completed for a previous application less than 2 years ago?YES 0 SIGN REQ r4 D OF PERSON BEING FINGERPRINTED FORM 147 'r. REVJUNE 2021 9/19/23, 1:05 PM Enterprise Mail-MANAGER'S APPLICATION FOR OMAHA CITY COUNCIL HRG-ELKHORN ORDER 3943 I"ell Carman Johnson (CCIk) <carman.johnson@cityofomaha.org> MANAGER'S APPLICATION FOR OMAHA CITY COUNCIL HRG - ELKHORN ORDER 3943 1 message t Carman Johnson (CCIk) <Carman.Johnson@cityofomaha.org> Tue, Sep 19, 2023 1:05 PM To: FRATERNAL ORDER OF EAGLES #3943 Elkhorn Aerie #3943 <foe3943@msn.com>, JNAGLE69@live.com Bcc: "Elizabeth Butler (CCIk)" <elizabeth.butler@cityofomaha.org>, "Kimberly Hoesing (CCIk)" <Kimberly.Hoesing@cityofomaha.org> Good afternoon RE: ELKHORN FRAT ORDER 3943 The Omaha City Clerk's Office has received the Manager's application from the Nebraska Liquor Control Commission. The Omaha City Council will hold a public hearing on this request on Tuesday, OCTOBER 17, 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 JASON R NAGLE. 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 https://mail.google.com/mail/u/0/?ik=cd387c45eb&view=pt&search=all&permthid=thread-a:r7632305345105490801%7Cmsg-a:r-78597360483343365... 1/2