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RES 2018-0389 - Olive Garden Italian Restaurant #1302 appoints Kimberlee B Stonys manager of class I liq lic loc . ' E-MAILED TO NLCC to -4---" �F'.4s.—srq='a, — y; 7 . ,141 *,- l. p , , STATE OF NEBRASKA IF :. "�~ A�0 Pete Ricketts ' ' F L ' NEBRASKA LIQUOR CONTROL COMMISSION A'. �`j Y ini a\.,:% .. � Governor Hobert B. Rupe O\'Yi 1 Ise pp p[� Ail 9. Executive Director 'r+ ' i " Gh d U�tA(1 Fay 1 2�� 301 Centennial Mall South,5th Floor �R P.O.Box 95046 . • Lincoln,Nebraska 68509-5046 CITY C L E ' Phone(402)47I 2571 Fax(402)471-2814 or(402)471-2374 I' ;'.;s.'. N t T.ii, 3 I r It TRS USER 800 833-7352(TTY) Web address http://www.lcc.nebraska.gov/ • 3/26/2018 . • • To: CITY CLERK OF OMAHA Email: CARMAN.JOHNSONCa�CITYOFOMAHA.ORG Manager Name: KIMBERLEE B STONYS Licensee Name: GMRI INC . Licensee Trade Name: THE OLIVE GARDEN ITALIAN RESTAURANT#1302 License Number: 1-032482 Due Date: Thursday, May 10, 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): .I L hi 5m . ,p ,�.,' I � Y, oic- ClerkP• . • . . Signature: C —� Date: ZJ—Z&—1 . 11 0 1 0 1 0 1 ii illi 1 1 1 Janice M.Wiebusch Robert Batt C'umrnEc.cinner Chairman 1800004092 kr Equal Oplarrlunm•l:•nr ph)yer . MANAGER APPLICATION Office Use INSERT-FORM 3c RECEIVE. NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH PO BOX 95046 OR 23 '611b LINCOLN,NE 68509-5046 PHONE:(402)471-2571 AsKp,LIQUOR FAX:(402)471-2814 O�� �I COMMlssbOM Website:www.lcc.nebraska.gov MUST BE: ✓ Citizen of the United States. 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 a3^ �r- i ..�- � �_>v -x�al�re. .e �' �iA` � "S �� �'�3�'`P��. L .- s. �,=:=t. x ',{+�,,..... r Q � a,,,�nW,�t4iltC _., � ..o.{'.Y`if_EYxan:: .z• ai i. �'S..;� a"t ,M, 'a�,'' .�' ig �i .r° 3.x» _ �.....�... ,�'�-_ Y�".a.deEaa�xa....r..t `�.�#c�..:dt�,a..�,.ba-x'�u«�&�.._....W.'���.�'s;xa. .'�fra��:... . � Name of Corporation/LLC: GMRI, Inc. , �yw, ,�.�^" c '1'7'"'- .r%;nw.�.,f.° ": -a .� "', -�sr� 7�*" +,'"€f YS: ' r c; ,y RF et �- '�c^' S.�c.� 'Et��. F aira. r� '. ''s� � tit' t s t 7 p,t :.r 7-7,74.'' 1747 +C s.,.,F.... .. :.a,.,ar, -.:✓•. am;.;' 4.-. i,.. .. .k�.,.hr7 1....;,,r5rA): Liquor License Number: 032482 Class Type (if new application leave blank) Premise Trade Name/DBA:The Olive Garden Italian Restaurant #1302 Premise Street Address: 7505 Dodge Street city:Omaha county:Douglas Zip Code:68114 Premise Phone Number:(402)393-8404 Premise Email address: ELahens@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. SIG µ REQUIRED BY CORPORATE OFFICEiCA ANAGING MEMBER .(Faxed signatures are acceptable) Colleen M. Hunter, Assistant Secretary • Form 103 Rev Jan 2018 Page 2 of 6 Manager's information mustbe•completed beIow PLEASE PRINT CLEARLY Last Name: Shn .S First Name:W k1 X Leer MI: Home Address: 3 w t, �. gs}h Te rra.e_1✓ F pf. 10 City: E t k-h nr n County: VIE Zip Code: w 6 OaD, Home Phone Number: 40(3— W 175C1 Driver's License Number& State:_ / N e,bra s Social Security Number:_ Date Of Birth:_• - _ _ _ Place Of Birth: ©(11�Q..) NF Email address: n� l�3 ma 1 .co 9 *Are_you married?If yes,complete sp©use's information(Even if a spousal affidavithas been submitted). :.; ❑ YES NO Spouse's information x3' `. ! 4 y 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)'FT*THE PAST TEN(10) YEARS APPLICANT ' .,_ _ ' .. SPOUSE .M + 4,j CITY & STATE YEAR YEAR CITY & STATE YEAR YEAR FROM TO FROM TO Ow ct • NEL. 1t7► Ui`1 _ Dc\-- Uii a, NE. )u anent. Form 103 Rev Jan 2018 Page 3 or6 • 4 MOTA- ggt IAST TWO,EMPLQYERS . , : -567 1' n *' z YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE FROM TO NUMBER Curra ©U* r() 6arc n pbegOr\ 40a-vi-9--(430 aOt&' 01 - R .ri c a( WSi'nc b E(\C..Lnc4.S '31a-390 3)o(a I. READ CAREFULLY. ANSWER COMPLETELY A D 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 ❑ 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 �� � ,� �i l c vtr� �l f �C%CLI C' ,ai ,crlci1�t1>�S i, �I) c 4G j,OTc" ck,(�� o r.iost L 2. Have you or your spouse ever been approved or made application for a liquor license in Nebraska or any other state? [YES IF YES, list the name of the premise(s): 3. Do you, as a manager, qualify under Nebraska Liquor Control Act(ti5 131.0I) and do you intend to supervise_ in person.the management of the business? YES fNO Form 103 Rev Jan 2018 Page 4 o1 6 • 4. List the alcohol related training and/or experience(when and where)of the person making application. *NLCC Training Certificate Issued: Name on Certificate: Applicant Name Date Name of program(attach copy of course completion certificate) (mm/YYYY) • • *For list of NLCC Certified Training Programs see IraininC Experience: • Applicant Name/Job Title Date of Name & Location of Business: • Employment: • • 5. Have you enclosed form I-17 regarding fingerprints? F YES FIND • Form 103 Rev Jan 2018 Page 5 or / • .fttikN ' UATH b CONSENT F INZ? ST GATIONn 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 `5 S-I 31.0I)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, C'FR, 16.34. Sig ture of Manager Applicant Signature of Spouse • ACKNOWLEDGEMENT State of Nebraska County of .TL&C+ ((,.(.S The foregoing instrument was acknowledged before me this Ma\I i.1,'A 12D1-1-) 120I% by KiYYIVXV �f S"1"C-'MS date NAME OF PERSON BEING ACKNOWLEDGED /11/0' JV F l l 01( �. Mir:Seal Notary Public signature : GENERAL NOTARY-State ofNebraska SAMANTHA SCHNEIDER My Comm.Exp.Sept.1,2020 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 Jan 2018 Page 6 of 6 • • SUBMISSION OF FINGERPRINTS / RECDVEIJ PAYMENT OF FEES TO NSP-CID NEBRASKA LIQUOR CONTROL COMMISSION .k 2 3 2018 301 CENTENNIAL MALL SOUTH PO BOX 95046 . NEBRASKA LIQUOR LINCOLN, NE 68509-5046 CONTROL.COMMISSION PHONE: (402)471-2571 use o ,Iy FAX: (402)471-2814 W b<i':L: v1;v.lcc..ncbrasl.a. is. Class:.---.,_-- License#:_.._ Applicant Name: k t ' I l be'r Lie g S • (Corporation,LLC,Partnership or Individual) • Trade Name: nu ,, , (�,I 9 !'l i 5O a (Doing Business As) V-Ston S ta3P9mct,c, cAD rn Phone Number Contact E-mjAddress 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 websilc 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 k\ww.ne.i.iov I o/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 vivau-ucuiaZna • •Grnail Kim Stonys<kstonys123@gmail.com> nebraska - Receipt P 1 message • nebraska<NoRepIyOTC@egov.com> Tue, Mar 13, 2018 at 5:22 PM To: kstonys123@gmail.com PURCHASE RECEIPT Nebraska State Patrol-Criminal Identification Division • 3800 NW 12th Street. Suite A Lincoln NE 68521 (402)479-4971 • Antonina.Anderson-Trumble@nebraska.gov OTC Local Ref ID:23281390 THANK YOU FOR USING THE NEBRASKA STATE PATROL PAYPORT SERVICE Status: APPROVED Customer Name: Kimberlee B Stonys • Type: Visa Credit Card Number: "'""'""''"" • Total Amount Charged USD$46.38 Items Location Quantity TPE Order Total ID Amount Liquor License • 1 28182130 $45.25 Applicant Name: Kimberlee Stonys Date of Birth: Last four digits Soc. Security Number: Total remitted to the Nebraska State Patrol-Criminal Identification $45 25 Division • • • • https://mail.google.com/mail/u/0/?ui=2&ik=93 6287090f&jsver=kBTDgkppgMA.en.&vie... 3/13/2018 DOUGLAS COUNTY SHERIFF WEST Date: 3/6/2018 2:35 PM TR: 27 Receipt 1:09194885 KIMBERLEE B STOWS Sheriff-West $21.50 1.00 Fingerprinting $15.00 1.00 Copy - Fingerprint $5.00 Convenience Fee $1.50 Payment Total: $21.5U Transaction Total: $21.50 VISA Tendered : $21.50 RECEIVE '{ . 23 `1.01ii NEBRASKA LiUU'OR CONTROL COMMISSION . 4..AHA N, City of [Are Omaha, bras&a A�° . p. rAf; 1819 Farnam— Suite LC 1 zV. Omaha, Nebraska 68183-0112 0 ,00 Elizabeth Butler (402) 444-5550 • ,y, City Clerk FAX (402) 444-5263 a9 `' TED FEBRVA • • April 10, 2018 GMRI, Inc. Application to appoint Kimberlee B. Stonys Dba"Olive Garden Italian Rest. #1302" manager of your present Class "I"Liquor 7505 Dodge Street . License location Omaha,NE 68114 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 April 24, 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 o_f 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, q'iebrasa �°� : 44vitp ) mtAtimpil, .- 1819 Farnam — Suite LC 1 2 ie� c:�; '� usurz Omaha, Nebraska 68183-0112 ner r titig _ , co Elizabeth Butler (402) 444-5550 �•o` _� ti- City Clerk FAX (402) 444-5263 o�P,�' � �'=S4`� TED FEBR‘3- April 10, 2018 Kimberlee B. Stonys Application to be appointed manager of the present 363 North 185th Terrace, Apt 101 Class"I"Liquor License location for GMRI, Inc., Elkhorn,NE 68022 dba"Olive Garden Italian Rest. #1302", 7505 Dodge Street, 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 April 24, 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