RES 2018-0463 - Walmart 4358 appoints Bryan E Bell manager of class D liq lic loc E-MAILED TO NLCC 5✓ •
Cis
a: .� ... '.2 4
f �. .�.. : A STATE OF NEBRASKA
<; "'�~ ?0j Pete Ricketts O NEBRASKA LIQUOR CONTROL COMMISSION
Wes° ` -' � 20IE APR 23 1` 58
Hobert B. Rupe
a',• ;- .� Governor �t 3: p
r 1 Executive Director
•
e 301 Centennial Mall South.5th Floor
''Rai r iec
r J �V �- , P.O.Box 95046
Lincoln,Nebraska 68509-5046
F' '� A Phone(402)471-2571
,.v.E s..,�
Fax(402)471-2814 or(402)471-2374
TRS USER 800 833-7352(TTY)
Web address http://www.lcc.nebraska.gov/
•
4/23/2018
•
To: CITY CLERK OF OMAHA •
Email: CARMAN.IOHNSON@CITYOFOMAHA.ORG
Manager Name: BRYAN E BELL
Licensee Name: WALMART INC
•
• Licensee Trade Name: WALMART 4358
License Number: D-082609
Due Date: Thursday, June 07, 2018
I have attached a copy of a new manager application that was submitted to the Nebraska Liquor
Control Commission. Please complete the following information below to indicate your .
recommendation. Send back to TRACY at tracy.burmeister@nebraska.gov or fax to 402-471-
2814. If you have questions concerning this matter, please contact our office at 402-471-2572.
APPROVED •
NO LOCAL RECOMMENDATION
DENIED
COMMENTS (YOU MAY ATTACH MINUTES AND/OR ADDITIONAL NOTES):
s 141126 ./t A- 1 s j a u•
•
Clerk Signature:
Date: 5/Jti1l
Janice M.Wiebusch • Robert Batt
• ('unmusciooer (ln,irm,,,-r 1800005421
.4)?!Equal()ppm-Fundy Employer • .
Apr 19 2818 14:27:27 CDT FROM: F2M/88361416554 MSGII 1628918869-887-1 PAGE 882 OF 015
MANAGER APPLICATION orrxroot
RECEIVED
INSERT- FORM 3c
NrifIRASKA LIQUOR COsTROL COMMtssioti A PR ` t� T�f tot-CINI'1 NIALMALLSOL`T11
t.tN OL',:*�e:ai15O9.St�t6PII NEBRASKA LIQUOR
FAX: 14o t'41t 7t.Zs?1 CONTROL COMMISSION
FA'{:idD.j d7l:akt.t
1Yzt»iie:.+si+ ,lacac3+rastrs.gar
FORM M]L'ST BE COMPLETELY FILLED OUT IN ORDER FOR APPLICATION TO BE
PROCESSED
ACER MUST;
• Complete all sections of the application. Be:ware it is signed by a.member or enrol:rape officer,
corporate:officer or member mast be an individual on file with the tagao=.Control:Cotnnrission
• Fiagctprints.ar'e required. Sec fttn .147 for further information.toad form carefully to avoiddelays
in processing;,.this form MUST be included with your application.
• Provide a copy o.f.i nc of the following: US birth certificate.naturalization papers et.dissent US
passport(cti en.ii 1you liaVe pit+uvided this before)
• Do a registered voter in the State uf:l`I,:Br 1LN include a copy of voter card or,prim document from
Secretary of St;.website with applie ation
Spouse who will not participate in the business. usenttrst
• Comptcic the Spotlit Affidavzit:of Non Panicipntian insert(must be notarizes*. The non-
participating sponse vompletes the top bait-the anger completes the bottom hail. Re sure to
gnrnnkle bhttt halves Of this ferny
• Need not answer question a1 of the application
Spouse who*_1l1 participate in.ihc business,the=w must
• Sign thc application
• Fingerprints are required. Ste for 141 for farther information.mad form carefttlly to avoid delays
in processing,this form MUST be inetuaicd 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 P:uiieipation Insert not required
1191
it"i1A*$
Par 1oQa
Apr 19 2818 14:Z8:13 CDT FROM: FZM/88361416554 MSGtt 1620918869-007-1 PAGE 083 OF 015
MANAGER APPLICATION crirKzt RECEIVED
INSERT-FO101.3c
ccU tASK .:LIQUOR.CONTROL COMMISSION r;P R 2 0 2018
34?i'aN711 tNIAt,ltiALL SOUTH
iron It r93a
LINCOL 3,.NE ss09-51u6 NEBRASKA LIQUOR
PHOSE:Oo 471,25jI
Ir4,74:(`2)47t-1t;I1 CONTROL COMMISSION
Webxit:Hovey Ire nctimaa.gcv •
MUST RE;,
✓ C ti7ta of the tjtiited Slates. Influsicsoy of_UJS birth ten'licpls.mturiGzation paper or Nr titMVO
3L�
✓ Ncbri lei zesidcwft iicludt.c +y trl'voter,n g t tioit"t 4rd or tail out sloru c ifrom Sccretnry rf
✓ FittgetpRtttc Scc-.fomij47 for firmer information.tzad form carefully to avoid delays in
prong.this form MUST be included with your application
✓ 21 year*.orate or older
. ... .. .�.. -� �� .�c +�� ^��' �arm��s 5�e��:.,��,. a.�-. *r+�a, h ,�ar�„ �, �. -.
/cePTItgl .7/' �r a r..a.' 1 k f r +E 1 r� �r ... Hi^p.:i'.tr` 1rA,+ gat i E 7 3?tx
.`.1�.�^!''�"r/�ll�..~.�*'��11�.,nt�r1w�tG��i-+,�/k'�;LFm'�t �d'�l-.�3 F.w�rs�'�at� +vpbn..3Gi r�r,'ki�'�>,+.,*+,.c�ru�.w �r� o,ws�i.+'wykS��'..,u.�,Ee��'c�" �.
>`ameofCorporatiOntLI YVOt,O�`t 1VIt _ �t —
� . • a... , r ` ^r'-�^ .+� marw � s-t•^. ys+ a�s'�.,��, c'�^s^ ^r� taw `�,`:"�"F,��.;'
.+'.ilii"-yy,� P r-- fRr"h'�''T' '`.,xi,y,M"�� '� `� r'�tidi++.mv`esJ-icu. "x«.� l.+g�IF ti°:fr,t,r,.EE.l .xtvt"w.�' z'�:K^�
IJ1'M' Urlx%{4 oN���+ 'S;"`'rt're�1A&F+::n.Yxw'f+r�+ayl v Ia`d
Liquor Li.Ctritisc huttib r: `x Class Type. Q corn.- d.i' �ts,4)
Prem se.Trttk grun ID9A:V V°,IM(XY
rremise Street Andress: WI t)tQ 5 11.0.1i St-
City, (1 Y t 4tA\Ut Caunty; .0 1&S . Zip code:,UW/1,A
Premise Phone Numbcr:2i DI- ?Pt 66tpD
FrLmisc.Email address CVCO 11C, a\r M.tn...l • LV 1 T
The individual whose_name.is fisted as tt corporate officer or mtinazing member as reported on insert
form 3* or 3b or"llitted:with the Commission. to see authorized officers or members search your
liceaae Iat:ormothin hi;
aiVA-
W" v
(F tcxl% 1ntttres'tiro riCGcptab1 )
verts voi
Re*)ae 201N
Nr:ors
Apr 19 2010 14:29:25 CDT FROM: F2M/00361416554 MSGA 1620918869-887-1 PAGE 004 OF 015
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Last Narnc: L First I�:vtw:: a�+. Mt;
• Horne Addrexs:, l (( .: .. ' 4_..,. "''� St-
City "be:' tt sat. County: S.Ai.-.. Zip Code: L I2.,
flume Phone Number. r .' 13', ` "
Dnver•s License Number&State: • N .2 ...
Social Security Number:
Date Of Birth:._ I'tace OF Firth:. 44AKikitte44.
Email address: ??r.t ' : 5 ,r►,d1,.tfafai •:•�►
W .y,. r _... « 4 nwy..r. ,'vn'S' :wigrrx trlil'*.,w.#0.+fi af 're`L�f,-W�F�' R
jYES . CI NO
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11 xS ii1. ...... 1tlr S
$p�i1 l:�it�s'ttiiC: � ...,.�.....�.,, fa*
Social Security Numbcr--
Driver's License Number&:State:_. ...,,,._,,. , . l f . 4.# i ►,..
Dace Of#3.i :. ► Race Or Huth:_... ;.6�. . .W O
ga. cOrClif��£C' FV ' .�"4V410
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wn wa.aa.,,,< .�a3.icz.. a-.r �a. t
CITY&STATE: YE"" WAR STA
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&FROM TO FRONI
STATE
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Apr 19 2818 14:31:82 CDT FROM: FZM/88361416554 MSGU 1628918869-887-1 PAGE 885 OF 815
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•
YEAR TELEPHONE
NAME'OP EMPLOYER NAME OF SUPERVISOR
_FRONT TO „ . • RTti TIER
S tort tej ;
i, READ C R:En-ILLY. ANSWER COMPLETELY AND ACCURAT174,1.!'.
fi�:tsst iti cornpleled by both applicant and spouse,'uah ss spouse has flied an affidavit of non-
participalion.
Has anyone who is a patty to this application,.or their spouts. td.i' been convicted or or plead guilty to any Oargc.
Chant;exam any charge 11cgin a otitdcmcanor.Violation of a federal or state law.a violation of a local law,
ordinance Of r soltttlott,tow
tiof.the charge, where the charge occurred and the year and. month:ofthe
' u t conviction or plea. othe nutoccurredot { Also lisa any charges.pending at the time of this application. I r morc:than
one party. please lit1 Outgo by sac r ih�divJtlital'x:tlattne: Caattttdsvtioo must be notified or any arrests andior
cone ciiona that may occur taller the date oftsi nittg this i►lsplitntiort.
El YES 0 NO
if yam,please c plain below or attach a separate page.
Date of Whore Description i
Narnc of Applicant Conviction Cortvictcd of i Disposition
(ttttrt{ I State) . . , Charge .
i . 1
r.\. l tP 4s- . # ' .. . t 1: {-to. +�-a a,: Luella
• t�� i +,. tx.i kW...6A,, tit
. .. ..vwW:iwr.v:w..b .�+..».....- •1.—..+o..s4+.+rv.r.,e...
2. Have you or your spouse ever Seen approved or made application for a liquor license in Ncbra$ca or
any other slate
DYES
IF YES,list the namc:afthe:premisees):
3. Do you.as a manager,qualify under Nebraska Liquor Control Act[ 5z-1 x l.fs1)and do you intend to
supervise,:in pavan,the management of the butinct tilYES ONO
roma la)
Ret 34 ':AI$
rir+ra at.
Apr 19 2810 14:32:88 CDT FROM: F2M/88361416554 MSG# 1628918869-887-1 PAGE 886 OF 815
4. Lim the akohol rclatcd paining and/or capericnce(wheel and where)of the ppcmon matting application,
'WA Vining Ccrtifiwtr['dual: Nrmc on Ccttifkatc;
Due
Applicant Namc [. } iNb.fl or pt raiafift cbc,ps cif cox*can+pfrtianrertlt5e►Zcl •
•
•aa I'M ofNJ..CCCertifird 'ra ni Norio*lottrntte'ing.
Applicant Name.(Job'Tittt 441c Qr Navrie&Luca on c `B irnt ss,
roploy ictill
5. [tart you enclosed jJ-.re ding-:fingctprints?
jYES ONO •
Now tat
Apr 19 2018 14:35:12 CDT FROM: F2M/88361416554 MSGit 1628910069-007-1 PAGE 009 OF 015
01.NIS l'agcI of I
Walmart
e ikrit
Certificate of Completion
These to of*carviet.on
of
Alcohol Sales Training
BRYAN BELL :1Q/12/2017
M.100400 Data
htiirilgims.wolquarixon4Intstapplmanutternentri.NIS_ActRcporis.aspx"MoiLiziu2,6&.1_1„, 4 j i 7:201g
Apr 19 2818 14:32:56 CDT FROM: F2M/88361416554 MSGIU 1628910869-887-1 PAGE 887 OF 015
'EF u. 4 K ace .Mtgf*rt a 17St*irk, r- t7 tgaeIR% .F'Zi
•
The above individ.uni(s);.boir►g:,tirst duly sti►om upon oath, deposes and states that. the .undersigned is the
applicantandtnr spouse OftipPlicantWhOlnaliattheabento and foregoing application that said applicatiion has
been read had t sat the+contents:ibcrcofatid all$.14Ctnrtts contained thereon afire true. If any false statcmcnt i_
mule in any part of this.appl f ton.. the applicant(S) shall. be *oiled guilty of perjury and subject to
petialtiics pras<<ittetl by .1Set 45 -j (,QJ V Ncb;tsska Liquor Control tact.
The undersigned applienot hereby consols to out investigation othiSilter.bat:kground including.afl records of
every kind and dcsctiption including:pollee records,.lax:r1eeerds.(State and Federal). and bank or lending
institution records.and.said:applicant.and sptittxc c.any rights ror causes.of atction that applicant or
spouse.may:baVC,ogaloit The Nebraslto LieLooi:Condo) Commission and any other iddiviiiiunl disclosing or
telcatirig said ihl'bnna tics to:the-Nat-Oki Liquor Cotitrol 6vaintissiop If spouse has NO intcrest directly ter
indirectly,:u spousal:affidavit ofnonVpatticipation may he attached.
The undersitmcd understand and acknowledge that any liccnsc icsucd,:based on the information submitted in
this application,-is subject to cancellation if thc infomialioit a Coittained.hereirt is incomplete. inaccurate, or
froodulent.
ApplicantNoticattaat and Record Challenge: Yourfbtgerprints will he used to check the criminal history
ri arils of-the FT31. You hare thc o{porruriity..tb dnrplcre ctr challenge the accuracy of the information
contain d.frt F131 idertiiftcratron record. Thr per i `urn foe obtaining a Change Correction, or updating on
FBI :idenrIkarlan record are sr rfu fat in Title;3 i C•F& .4
Sign* e ,litnagtr AkilItttnt Sl natore of Spouse
•
ACt:.NowzEDGEMENT
Slate of h`ebmslra
County tit The foregoing inttrument.was
rt iA acbtow.ieti�bcf rr me this
:.,.m-.. � ., �
by
art
11%w or pr.IC'oN iiCtic At"ktiovkiloGto
alit.Seel AXIOMM1t41`
Notorj�l'tihli@ xi luinc, ittttelit$00rtr060
In compliance with t e..ADA tNs:.ttpplication is available in other formats for persons with disabilities.
A ten day advance:period.is requited in writing to produce the alternate format.
meat
tars.
Apr 19 211113 14:34:BB CDT FROM: F2M/88361416554 MSG# 16213910069-807-1 PAGE BOB OF 015
SPOUSAL AFFIDAVIT OF orrKe trw. „.
NON PARTICIPATION INSERT
mlutAssA was(coNTIon,cosi srmso 1N
30t CLVTENVAL MALL scent
ro tiOX 43046 i
LINCOLM,NV oilo-fpie
OtIONE.(OM)Alt-701
FAX'WO!411.;1 t4
Vitboxit um*ics aranA114-VE .
11111 i acknowledge that I arn the spouse of a liquor license holder. My signature below confirms that I will
not have any interest,directly or indirectly in the operation of the bUsiness(453425tI3))of the Liquor Control
Act. I will not tend bar,make sales,serve patrons,stock shelves,write checks sign invoices, teplitSent Myself'
as the owner or in any way participate In Ake-day to day operationt nf thls boldness In any rapacity_ The
penalty guideline for violation of this a ffidatrit cancellation of the liquor license.
ailI acknowledge that I am the applicant of the port-omlicipitting spouse or eic individual signing below. I
widerstand that my spouse:and I are responsilde for etunplinne4 with the conditiOni Set out abrave. zr, it is
dderrriirweti PiAktrySpotise has violated( 51-12S(I 3))the commission may take!tiereveke the liquor license.
r I uk,itkiti, 7.'? Ai,
Si,,, tore ertoNPARTICIPATINC SPOUSE Signatitte tit-A-PPLICA NT
.\10 Print.tr,1jr1
RA 43 ltt91
*T. '
/Z tit Norne P c
Stale of Nebraska,County a f.151-NA-461-412:' SIalc of NebroaL.County of V)ONtildti&O
The foregoing instrument was acknowledged before= The forcgolttg instnonent was.acknowledged before me
this 11 Pyr-1. I ?A)it. (4ate) this n Ape:1-i -,Pleo idate,
"...,,d
byS.ICLALUAA P>tAl b F 1Dx.t.A._, . ,
Name of person acknovetifted NA enfperson atkoowledged
(tnditictual signing document) (IndiVIdual skulk document)
--1(11-a41.4
--.1r)lAXM,..3/1"prYN-1,71r-r-N
Notary Public Signature ' NI WWI PUN it Signmuct
_ 1
usu.%NOWIT413101 IiitiMM gjilla 1111L40401t411 Ida*
I je. mocourtm0000044 1 ailitickshinittielet
I wycaworasuawarainto :. *OPRIP.1211k001100*. :
la oisodlogi oleo tie AOA.iSit woo‘i inktgot of'ipko iggoopago ii ineakir IC.alier kraal'tat pawn 1610(dnakditlin.
A 4ra cliv blame pinta ii rot Ai i t titd iiit odawsit kii iii!. tbit kairoi#tiiimi
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Page I I
Apr 19 2010 14:35:39 CDT FROM: FMM/80361416554 MSG* 1628910069-007-1 PAGE 810 OF 015
RECE VEL.
SUBMISSION OF FINGERPRINTS /
PAYMENT OF FEES TO NSP-CID
NEBRASKA LIQUOR CONTROL COMMISSION NEBRASKA LIQUOR
CENTENNIAL MALL SOUTH CONTROL COMMISSION
BOX 95046
LINCOLN,NE 68509-5046 •
PHONE: (402)471-2571 Office Use Only
FAX: (402)471-2814
Class: License tt:.itU
Website: www.lcc.nebraska.gov —'--
Applicant Name:\N a V)°, \1\L
(Corporation,LLC,Partnership or Individual)
Trade Name: \Ca1Vy\rut 1-776c
(Doing Business As)
Phone Number Contact E-mail A ess
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 be submitted with the application.
Please complete information on the following pages for EACH person fingerprinted.
FORM 147
REV JAN 2018
PAGE 1
Apr 19 2010 14:36:17 CDT FROM: FZM/80361416554 MSG8 1628918869-887-1 PAGE 011 OF 015
1. Name:1221,1 J rkn \.t I Date of Birth: �_�•
t „„- Last 4 SSN:
Date fingerprints were taken: 411 �1\.\'I Location where fingerprints were taken ' ' yam
How was payment made to NSP? L P PAYPORT OCASH ❑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 0
2. Name: Date of Birth: Last 4 SSN:
Date fingerprints were taken: Location where fingerprints were taken:
How was payment made to NSP? DNSP 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 0
3. Name: Date of Birth: Last 4 SSN: .
Date fingerprints were taken: Location where fingerprints were taken:
How was payment made to NSF? DNSP PAYPORT ❑CASH OCHECK 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 0
4. Name: Date of Birth: Last 4 SSN: '
Date fingerprints were taken: Location where fingerprints were taken:
How was payment made to NSP? DNSP PAYPORT DCASH ❑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 0
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): 1 Y/ip 11, lN(,.Qii 1!/ Title:!t") ..t)-cie YMOGI
1 SIgnature: aAACtA"'\----3.----- Date: (4,115( l
FORM 147
REV JAN 2018
PAGE 2
�MAHA, N
City o Omaha, �Webras&a x41 9s
1819 Farnam — Suite LC 1 z WV?� � '� ►.
Omaha, Nebraska 681 83-01 1 2 � i"r '�� ,, C
Elizabeth Butler (402) 444-5550 'S,o` r ,.
City Clerk FAX.(402) 444-5263
9T�D FE13WN3
May 1, 2018
Walmart, Inc. Application to appoint Bryan E. Bell
Dba"Walmart 4358" manager of your present Class "D"Liquor
1606 South 72°a Street License location
Omaha,NE 68124
•
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 May 15, 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 Omaha, Webras&a
1819 Farnam —Suite LC 1 MOO
Omaha, Nebraska 681 83-01 1 2 c2cip 41,4wco
Elizabeth Butler (402) 444-5550 •0
City Clerk FAX (402) 444-5263 o
TED FEBRUA
May 1, 2018
Bryan E. Bell Application to be appointed manager of the present
14802 South 22°' Street Class "D" Liquor License location for Walmart,Inc.,
Bellevue,NE 68123 dba"Walmart 4358", 1606 south 72t Street, 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 May 15, 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 Butter
City Clerk
EB:clj