Loading...
RES 2018-1113 - Old Vine Wine appoint Ricky Lee Plambeck manager of class C liq lic loc E-MAILED TO NLCC )62- I Y oSt £1,1 - - -- -- �"tia STATE OF NEBRASKA o . NEBRASKA LIQUOR CONTROL COMMISSION ;j Pete Ricketts Hobert B.Rupe �xj Governor Executive Director 301 Centennial Mall South,51h Floor • '�tRcrt r= g�'1 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 http://www.lce.nebraska.gov/ NOV 6'18 Pm3:59 November 6, 2018 CityCl_rkOmahaHE-RI_UDl • To: CITY CLERK OF LINCOLN Email: carman.johnson@cityofomaha.org Manager Name: RICKY L PLAMBECK Licensee Name: VIOLET@HEALTH&BEAUTY.LLC Licensee Trade Name (DBA): OLD VINE WINE ��,�� License Number: 1.13941 C u.1Y�AC I U Date Due: December 21, 2018 • I have attached a copy of a new corporate manager application that was submitted to the Nebraska Liquor Control Commission. Please complete the following information below to indicate .your recommendation. Send back to Kim Frederick at kim.frederick(a�nebraska.gov or fax to (402) 471- 2814. If you have questions concerning this matter, please contact our office at (402) 471-2573. APPROVED NO LOCAL RECOMMENDATION DENIED COMMENTS: (YOU MAY ATTACH MI UTES AND/OR ADDITIONAL NOTES) e-P5 'fl Pe—r Jo he „?a/j Clerk Signature: Date: 1 i� . KMF Robert Batt Bruce Bailey Janice M.Wiebusch Cammissioner Commissioner ChairmanConimissioner An Equal Opportunity Employer MANAGER APPLICATION Office Usc INSERT -FORM 3c RECEIVED NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH SEP 10 2018 PO BOX 95046 LINCOLN,NE 68509-5046 NEBRASKA LIQUOR PHONE:(402)471-2571 FAX:(402)471-2814 CONTROL COMMISSION Website:www.Icc.nebraska.gov 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 • 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) • Be a registered voter in the State of Nebraska, include a copy of voter caid 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 BARCO1}I_. Form 103 REV AUG 2016 Page 1 of 6 MANAGER APPLICATION Office Use RECEIVED INSERT-FORM 3c NEBRASKA LIQUOR CONTROL COMMISSION OCT 3 1 2018 301 CENTENNIAL MALL SOUTH PO BOX 95046 LINCOLN,NE 68509-5046 NEBRASKA i iQUOR PHONE:(402)471-2571 n r' FAX:(402)471-2814 CONTROL C'�1i " '',SION Website:www.lcc.nebraska.gov MUST BE: . V 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 Cq ioration/LL 'information , ~, K, ' ^` .1 .''. ;° �, .,�; 1, ,. .�' .. } _"- - 1 4,. -n...3,i Name of Corporation/LLC: V X.o\ Q4- • eL,L ' Sj (,L,i.t -1/ t ./ 1remis. ,in'fo m`ation 27.--- „ ,,p 77 _-_ ti;.-.-. y,—,,,--_;--v- .-7- I' � �ar..i� Liquor License Number: 1 12p l L4 Class Type (if new application leave blank) 'Premise Trade Name/DBA: Of) J l I V \A) /Premise Street Address: 3Q ? -t ( � C• I L ," . " SkQ J _ k LS ✓ Vi City0M(1.1 'C-, County: -DvL61 (.,G), Zip Code:lU l LP //Premise Phone Number: L-k0--. gC)I �- ` j� '!Premise Email address: 0 L-0 V \jL'LlW lN>✓ e1 -1-1S@Q- WAl (_- C ow) 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. 0,0,_AA- ‘—'0Uf CA �,. leeSIGNA UREREQUED'BY CORPORA TE:OFFICER/MA^NAGING=MEMBE R (Faxed signatures are acceptable) III II I II II III III II II 11 11 103 1800013664 Form Rev July 2018 A Page 2 of 6 ?). 1 \ ° ck> !ICEstriaier5 r Last Name: 0a4fyi First Name: V.A.4...)14-0 mr: Home Address: -1 \ s. City: Lc..,L,V County: (Ai Zip Code: (02) (-2-"Do Home Phone Number: (Lk 02- L4 2— . Driver's License Number& State: Ne Social Security Number: _ Date Of Birth: Place Of Birth: 0 NY.k.kia-- AL2—, Email address: kr-kV i ne..AAJ e-,cf ir se. ryla-i I • &oni 1.775:atlied7,1f.37-CTimpiere'siTo.uTes info-ilriitio-QTEVen fajpoiiiiraffidNiThlaseeTisubm-illedji \RI YES FINO 477,4e 4,;-7 ,j---73"': 41' 1q Spouses Last Name: Oa_ First Name: lQ Social Security Number: Driver's License Number& State: Ne2 Date Of Birth: Place Of Birth: rXiiPLICAlgir iergfoif§E MUST LIgtlasiNcE(§rfoqi*Willsi(1:4).i7kAks:• ` ,1,..ke A-4 _ _ SiL 4P* 211 YEAR YEAR YEAR YEAR CITY & STATE CITY& STATE FROM TO FROM TO Ltk_V Okla. \6,-, dOe: 700 201(4) Form 103 • REV AUG 2016 Page 3 of 6 3 YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE FROM TO NUMBER ,t,S ett, //k e'i Uo c 2e5/G 10/7 Sou.-144 /(,s4u.ZerS 44:,4 is rots, 1 r✓n nude-VI 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, E'ER 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. Ri YES n 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 pt,,4,19„,t,. ,720/c ap,.6.7ee seegcti3 2. Have you or your spouse ever been approved or made application for a liquor license in Nebraska or any other state? VIYES fNO IF YES, list the name of the premise(s):0/07 446 �i/fe 3. Do you, as a manager, qualify under Nebraska Liquor Control Act 053-131.01) and do you intend to supervise, in person,the management of the business? g-Es �NO Form 103 REV AUG 2016 Page 4 of 6 4. List the alcohol related training and/or experience(when and where)of the person making application. 641a/41c-9 APrOk-e 'ee,sio,1c -PorA olt-5) *NLCC Training Certificate Issued:PM l) Name on Certificate: list`Kcelcsj 21 P�,,lJP1 Applicant Name Date (mm/yyyy) Name of program(attach copy of course completion certificate) Ptu.vv.hec4. b<I,ZO/to MO ( /e ee/fra, / d1;5 *For list of NLCC Certified Training Programs see training Experience: Applicant Name/Job Title Date of Name&Location of Business: Employment: +—' • "1L3 /�ji��It Ay, f��a -ZU �P �4 f��/dl� �t��n 2 I td+Svf4Ec LdV+f`t‘J.e �T13S on,e. . QAc.Ly.. la. st r� Noz- �i.As,1,�-R,�- +SphnisSre 1(v- ZO 17 0u44A:e-tv,/6(A-ten (�Jis,e sp(�,�5 * ff,33 s t i r ai 7 • 5. Have you enclosed form 147 regarding fingerprints? [YES 11NO Form 103 REV AUG 2016 Page 5 of 6 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 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. Sig Iltu a of Manager Applicant Signatur of Spouse ACKNOWLEDGEMENT State of Nebraska ri County of /. rp y The foregoing instrument was acknowledged before me this Oe+O•her &K, 62b1 by I�Jt A /dAe /' date ME OFRSON BEING ACKNOWLEDGED :4Q 1_ / a 6/4/ Affix Seal PAULA A KNOEP FEL Notary Public sign General Notary-State of Nebraska My Commission Expires Jan 31,2022 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 • Nov.06.2018 11:51 AM PAGE. 1/ 2 . :.?ERBUNAL OATII AND,CONSENT OttOgtiMGAT,I+<)N ;_ 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 applicunt(s)shall he deemed guilty of perjury and subject to penalties provided by law. (5s;q 53-13E_.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 fingerprintswill be used to check the criminal history records of the 1:131. • You have the opportunity to complete or challenge the accuracy of the information container!in FIiI identification record. The procedures for obtaining a change, correction, or updating an F(31 identification record are set forth in Title 28, CFR, 16.34. 'ignature of Manager Applicant Signature of Spouse • ACKNOW I.ltO(IEM EN'I' State of Nebraska County of. _ W ._ The foregoing Instrument was acknowledged!before me this by V 0t?\ T IZulvlix.0 u?c. NAME UV 1'1'3i$ON BEING AC;KNOWLF,a:M:n • • _ _ AMxticol No ry ub e signature , GERM ROTARY•MOotNobr EUZABETH EBERT r' . MY Comrn E><p.Apl 26,2021 In compliance with the AD)A,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. • RECE E I'ur d I03 Rcv,hilt'2018 • NOV 0 6 2018 Page 6ot.6 NE-B`5AT st' '1 ; C.)U R • SUBMISSSION OF FINGERPRINTS/ PAYMENT OF FEES TO NSP-CID DA.i €1 P L NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH PO BOX 95046 LINCOLN,NE 68509-5046 PHONE: (402)471-2571 Office Use Only • FAX: (402)471-2814 Website: www.lcc.nebraska.gov Class:6 .._ License#: ..�_'rYji H Applicant Name: V \(0Q� (etez... (Corporation,LLC,Partners ip or Individual) Trade Name: 0 1) `/ N W 1�'C (Doing Business As) V (U.PV 3.01 — 35S 0 t \J w k,v—ce i 2rt nnc� t.e©r� Phone Number Contact E-mail Address DIRECTIONS FOR SUBMITTING FINGERPRINTS AND FEE PAYMENTS: • FAILURE TO FILE FINGERPRINT CARDS AND PAY THE REQUIRED PROCESSING FEE TO THE NEBRASKA STATE PATROL WILL DELAY THE ISSUANCE OF YOUR LIQUOR LICENSE. • See Application Requirement Guide for listing of Fingerprint Requirements, found on our website under "Licensing"tab in "Applicant Guidlines". • DO NOT send fee payments to the NLCC—fees MUST be paid directly to NSP; • 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 3800 NW 12th Street Lincoln,NE 68521 • Fingerprints taken at NSP 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 will be released to the applicants; Fingerprint cards should he submitted with the application. Please complete information on the following pages for EACH person fingerprinted. FORM 147 REV DEC 2016 PAGE 1 1. Name: de-t'1 lu�` iY►bcG(L_ Date of Birth: _ Last 4 SSN: Date fingerprints were taken:tb,-2-23 i S Location where fingerprints were taken: I1 SP '1-(1 5, 0 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 ❑ 2. Name: Date of Birth: Last 4 SSN: Date fingerprints were taken: Location where fingerprints were taken: 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 ❑ 3. Name: Date of Birth: Last 4 SSN: Date fingerprints were taken: Location where fingerprints were taken: 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 ❑ 4. Name: Date of Birth: Last 4 SSN: Date fingerprints were taken: Location where fingerprints were taken: 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 ❑ 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 a FBI identification record are set forth in Title 28, CFR, 16.34. I hereby certify that fees of$45.25 per person have been submitted directly to the Nebraska State Patrol-CID office. The undersigned certifies on behalf of the Corporation,LLC,Partnership or Licensee that it is understood that a misrepresentation of fact is cause for rejection of this application or suspension,cancellation or revocation of any license issued. Name(Print): V- \( Q\G l l D e Title: �QJ _..� I Signature: 5I 46,��_. Date: 9)1 co FORM 147 REV DEC 2016 PAGE 2 Nov.06.2018 11:51 AM PAGE. 2/ 2 PRIVACY ACT STATEMENT/ 9 D a SUBMISSION OF FINGERPRINTS/ r ,......, RECEPAYMENT OF FEES TO NSP-C1D NOV 062018 NEBRASKA LIQUOR CONTROL COMMISSION • 301 CENTENNIAL MALL SOUTH NEBFIAS K LgQ OH PO BOX 95046 . .... ..` LINCOLN,NE:68509-5046 CONTROL COi`M SSION PHONE:(402)471-2571 CI!`—"-" FAX:(402)47 I-2814 Websile:www.lcc..nebrasku.go" THIS S FORM IS REQUIRED TO BE SIGNED BY EACH PERSON BEING FINGERPRINTED): DIRECTIONS FOR SUBMITTING FINGERPRINTS AND FEE PAYMENTS: • FAILURE TO FILE FINGBPRINf 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 l.)iRF CTLY to the Nebraska State Patrol; It is recommended to make payment through the NSP PayPort online system at www.nsa9v/go/n,sp 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 tingerpiinted)and the payment is for a Liquor Licensc*** The Nebraska State Patrol--CID Division 3800 NW 12'h Street Lincoln,NE 68521 • Fingerprints taken at NSI' LIVESCAN locations will be forwarded to NSP—CII) 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 he submitted with the application. Applicant Nutlfleation and Record challenge: Your fingerprints will he 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 procedure's far obtaining a change, correction, or updating a 1:131 identification record are scat'Ord,in Title 28, ('FR, 14,34. Trade Name: V IT'a 1eC QG� L, 45 ,2Qc;._._- Name of Person Bring Fingerprinted:._VOt Q -.. An bee.. 14-__---. Date of Birth: ., .. ,�. Last 4 SSN: —ate fingerprints were taken: \t l �, Location where fingerprints were taken;__ ta,Its--, `L-0\ .• l.0 ate'"-' S\- _.... How was payment made to NSP? plNSP PAYPORT ❑CASH ❑CHECK SENT CO NSP CK# y fingerprints are already,on file with the commission -. fingerprints completed for a previous applicati n less than 2 years ago? YES D _ ` 00__DthC — • SIGNA URE RE UIRE OF PERSON BEING FINGERPRINTED FORM 147 REV MAY 2018 CityofOmaha, SAle bras a �° �� ��� 1819 Farnam—Suite LC 1 \W11 :1.1, Omaha, Nebraska 68183-01.12 � ► Elizabeth Butler (402) 444-5550 • '�"�' � �= City Clerk FAX (402)444-5263 00 November 16, 2018 Violet@Health&Buety, LLC Application to appoint Ricky Lee Plambeck Dba"Old Vine Wine" manager of your present Class "C"Liquor 3 821 North 167th Court, Suite 145 License location Omaha,NE 68116 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 December 4, 2018 . 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 or his/her representative 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. Sincerely yours, Elizabeth Butler City Clerk • EB:clj • City of OmaI IOW sArebraskg OMp'HA,v NA. 1819 Farnam —Suite LC 1 .;i �40011 i �.r� tat Omaha, Nebraska 68183-0112 26Sr 0 47, ,;T "gk'r- w Elizabeth Butler (402) 444-5550 *0 ti City Clerk FAX (402) 444-5263 �P4 FDFEV ' November 16, 2018 ` • • Ricky Lee Plambeck Application to be appointed manager of the present 7713 South 75th Avenue Class"C" Liquor License locations for Violet@ LaVista,NE 68128 Health&Beauty, LLC, dba"Old Vine Wine", 3821 North 167th Court, Suite 145, Omaha,NE Dear Liquor License Manager Applicant: This letter is notification that a hearing before the Omaha City Council on your application to be appointed manager of the liquor license has been set for December 4, 2018 . 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 or his/her representative 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. Sincerely yours, Elizabeth Butler City Clerk EB:clj