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RES 2016-0904 - Appioint Heather L Rutledge manager of Spencer's E-MAILED TO NLCC (_% ._. : MANAGER RECOMMENDATION 7c, I, t:� Sr� ,,y r , DATE: May 18th, 2016 r TO: Omaha City Clerk E-MAIL: carman.johnson@cityofomaha.org MANAGER: Heather Rutledge LICENSEE: Spencer's For Steaks and Chops LLC LICENSE#: 1-102362 DUE DATE: July 5, 2016 Attached is a copy of a new manager application submitted to Nebraska Liquor Control Commission. Please complete the following to submit your recommendation. Send back to Tracy Burmeister at tracy.burmeister@nebraska.gov or fax to (402)471-2814, with questions call (402)471-2572. APPROVED NO LOCAL RECOMMENDATION DENIED COMMENTS: �(,i.[J 9 y pc',551 rX 6 d 1-I6, (may attach minutes and/or additional notes) et—,IX.5'46°"---- CLERKS SIGNATURE: ./5/ / / DATE: '/ a �( f MANAGER APPLICATION Office Use INSERT-FORM 3c 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.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 card 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#I of the application Spouse who will participate in the business,the spouse must: • Sign the application • Fingerprints are required. See form 1 47 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 = 4 Form 101 REV MAR 2016 Page I of& MANAGER APPLICATION Office Use E INSERT-FORM 3c NEBRASKA LIQUOR CONTROL COMMISSION M , 8 1 ` 301 CENTENNIAL MALL SOUTH PO BOX 95046 NEBRASKA LIQUOR LINCOL,N,NE 68509-5046 PHONE:(402)471-2571 CONTROL COMMISSION FAX:(402)471-2814 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 ww°ebsite ✓ Fingerprinted. See firm 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 Name of CorporationfLLC: D t t !A- 1--` T f N)F-4' ( t G )t Liquor License Number: I (J ? Class Type (ifnewapplieation leave blank) Premise Trade Name/DBA: ( G�C.k .�l. �^ -t- C-t 1L11 s Premise Street Address: ( d . I DTI- cv . City: 0 1114 County: b(),..) ($ 1-- Zip Code: (:›© I d Premise Phone Number: {" �.. , � - t . 7 2 g Premise Email address: C-LULor'tt�. • 9.12,4A.t.i.Arc. ,.. w o-t t • Co 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. ?0-1/4(..k SIGNATURE UIRED BY CORPORATE OFFICER / MANAGING MEMBER (Faxed signatures are acceptable) Form 103 REV MAR 2016 Page 2of6 ter► Last Name: pu.ficasc First Name: titaftri, MI: L Home Address: 5531 I1C6CCII 1 St Apt D'1 City: Ofl1Qkii County: DOUg lOS Zip Cod Home Phone Number.102)707- U553 g 1 ?OS Driver's License Number& State: E toiJoR NEBRA51(P' -m s ot4 Social Security Number: • CONTRCIL CO Date Of Birth: _ _ I Place Of Birth: 0 U I SO tl#ki terra Email address: hruf1esicie4prnccrsiO9nictit corn E YES jij NO Wau.00,14 4 " t 4 4t-titM•44 4444-11 Spouses Last Name: First Name: MI: Social Security Number: • Driver's License Number& State: Date Of Birth: Place Of Birth: YEAR CITY & STATE YEAR CITY & STATE YEAR YEAR FROM TO FROM TO Form 103 RFV MAR 2016 Page 3 of 6 Qihr Haa:€5' �,m �> YEAR TELEPHONE NAME OF EMPLOYER NAME OF SUPERVISOR FROM TO NUMBER N12.000i Meal- SPenteri-For Steal±c GtnjChoo Chad C1arK 0.02)2, :; J oL t Kighi-ldea Mfat+a art)C`c tiv Doin 'A-Ntd !e (111)3Vtr-12 12 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 Atly 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. ►`1 YES ❑ NO If yes, please explain below or attach a separate page. Date of Where Description Name of Applicant Conviction Convicted of Disposition (mmlyyyy) (City&State) Charge Hccitcr Rufltage 4mana tje. -6unpaiaourffeciitte 2. Have you or your spouse ever been approved or made application for a liquor license in Nebraska or any other state? EYES ,®NO IF YES, list the name of the premise(s). 3. Do you, as a manager, qualify under Nebraska Liquor Control Act t 53-131.01)and do you intend to supervise, in person,the management of the business? YES LINO Form 103 REV MAR 2016 Page 4 of 6 a r 4. List the alcohol related training and/or experience(when and where)of the person making application. *NLCC Training Certificate Issued:StrtEC I I Name on Certificate: 1-1-eaterr RL{t C Applicant Name Date Name of program(attach copy of course completion certificate) (mm/31M) Hrn er Rine 0112.01w are WI yAy 1c,1 Ireri KA LiUliis°: N *For list of NLCC Certified Training Programs see training Experience: Applicant Name/Job Title Date of Name&Location of Business: Employment: S er V -for &Iraq ard MOrch l '-praµ 57) "S 1Prt4 a go�,NE&P1DL gar 5. Have you enclosed lbrm 147 regarding fingerprints? (_ [YES E1NO Form 103 REV MAR 2016 Page 5 of 6 s i fi Ri R di i f H ,C s t i J C . I E ._ F 9 ww. . . 7.,,, cr) t_ (Li ' �'�"�, . r ri 1 ; � ; .. S €' ,^, r..w... '.. , #i_ t' w a f f y 4 +;�f SYEs.t_P(,a,2iw — 'Km..da axV wa.upw ^Jw^* Es4WxC@N% �4*/YPPE 5R� tiH' e _� ,.Ns �w�e. C�n&.x-,rvk.} m* x.Ma �xs advuw iwasc w .dLYl'+tL YAtax' r x xcu dy�Hr. "FW 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. C SignfafIanager Applicant Signature of Sim W '" ( CONTROL(80MMISSiON ACKNOWLEDGEMENT State of Neb aska County of The foregoing instrument was acknowledged before me this flA G-0-)A �Lekn by AV"�'__ LY AMEPE[tSBE1tClV EDGED tl OF Affix Seal Notary Public signature GENERAL NOTARY-State of - %ENNA LSIARCIA My Con&E>p.Jamuary 14,2018 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 MAR 2016 Page 6 of 6 SUBMISSSION OF FINGERPRINTS 1 PAYMENT OF FEES TO NSP-CID NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH NEBRASKA LIQUOR PO BOX 95046 CONTROL LINCOLN,NE 68509-5046 PHONE: (402)471-2571 Office Use Only FAX: (402)471-2814 \\ebstte: ��.1 ° 1,C.q bra'l . (Nv Class: License#:-- Applicant Name: O 11 1!11 c R i/}ui n +&trbu{} ftC (Corporation,LLC,Partnership or Individual) f Trade Name: S xncriA'- Y Ste,Dic� O ett (Doing usiness As) (i 2)2 0 - d rttied c. fl( rA nnai) co rn Phone Number Contact E-nail Address I DIRECTIONS FOR SUBMITTING FINGERPRINTS AND FEE PAYMENTS: • See Application Requirement Guide for listing of Fingerprint Requirements, found on our'Neh itc under "Licensing"tab in "Guidelines/Brochures". FAILURE TO FILE FINGERPRINT CARDS AND PAY THE REQUIRED PROCESSING FEE TO THE NEBRASKA STATE PATROL WILL DELAY THE ISSUANCE OF YOUR LIQUOR LICENSE. • This completed form MUST be included with your Liquor License Application and/or Manager Application or changes to: Corporate Officers or Stockholders, LLC Members, Partners or Addition of Spouse where new fingerprint cards are required(see New Application Requirement Guide). • DO NOT send fee payments to the NLCC—fees MUST be paid directly to NSP; Include a list of names covered by your payment to insure proper application of payment. • Fee payment of$28.75 per person must be made directly to the NSP; It is recommended to make payment through the NSP PayPort online system at www.ne.govigoinsp Or checks made payable to NSP should be mailed directly to the following address: The Nebraska State Patrol—CID Division 3800 NW 12th Street Lincoln,NE 68521 • Fingerprints are not required for spouses that have no involvement with business-Spousal Affidavit of Non Participation(Form 116) is required in lieu of fingerprints. • 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 MAR 2016 PAGE 1 1. Name:I-feather Row) c Date of Birth: ast 4 SSN: (Please print legibly) Fingerprints on file with the commission? YES El How was payment made to NSP? SNSP PAYPORT 0 CASH OCHECK SENT TO NSP Ck# 2. Name: (Please print legibly) Date of Birth: Last 4 SSN: Fingerprints on file with the commission? YES D 1 low was payment made to NSP? ONSP PAYPORT El CASH OCHECK SENT TO NSP Ck# 3. Name: (Please print legibly) •Date of Birth: Last 4 SSN: Fingerprints on file with the commission? YES 0 How was payment made to NSP? ONSP PAYPORT OCASH 0 CHECK SENT TO NSP Ck# 4. Name: (Please print legibly) Date of Birth: Last 4 SSN: Fingerprints on file with the commission? YES 0 How was payment made to NSP? ONSP PAYPORT OCASH OCHECK SENT TO NSP Ck# 5. Name: (Please print legibly) Date of Birth: Last 4 SSN: Fingerprints on file with the commission? YES 0 How was payment made to NSP? ONSP PAYPORT 0 CASH OCHECK SENT TO NSP Ck 6. Name: (Please print legibly) Date of Birth: Last 4 SSN: Fingerprints on file with the commission? YES CI How was payment made to NSP? ONSP PAYPORT OCASH OCHECK SENT TO NSP Ck I hereby certify that fees of$28.75 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): Heafricr Ruffccer Title:Man Signature: lit Date:05-n-tv FORMJ 147 REV A N 2016 PAGE 2 Page 1 of 1. Back ))rint YOUR RECEIPT Nebraska State Patrol-Criminal Identilicathat Division 3800 NW 12th Street.Suite A Lincoln NE 68521 (402)479-4971 MAY 1 Auto/Dna, Vidcrsoli-TrunthleOtebrlsk Transaction Id: 10147534 NEBRASKA LIQUOR THANK YOt:FOR 1,1Sr.SC1 THE NEBRASKA STATE PATROL PAYPORT SERVICE CONTROL COMMiSSION Customer Name: Ryan Mueller Credit Card Number ************ nebraska total amount charged 529,47 Items I.ocation Quantity Order ID Total Amount Liquor License 1 20701696 $28.75 Applicant Name:Heather Rutledge Date of Birth: Last four digits Soc.Security Number: Total remitted to the Nebraska State Patrol-Criminal Identification Division S28.75 io Back 5/1 7/20 1 6 City of®mania WthrasaDAHA, N or 1819 Farnam —Suite LC 1 i�1t Omaha, Nebraska 681 83-01 1 2 O'! ti y° ,,; Buster Brown (402) 444-5550 ry, City Clerk FAX (402) 444-5263 O� - *-D FEDO' June 7, 2016 Spencer's For Steaks and Chops, LLC Application to appoint Heather L. Rutledge Dba"Spencer's For Steaks and Chops" manager of your present Class"I"Liquor 102 South 10th Street License location Omaha,NE 68102 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 June 21, 2016 . 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, .01/1 /4°011' Buster Brown City Clerk BJB:clj CityCity of Omaha Nebraska OMAHA, N� 111i51819 Farnam — Suite LC 1 �"�`� r� r Omaha, Nebraska 681 83-01 1 2 '. '► '^ Buster Brown ���y_ � m _ ? `' ^ (402) 444-5550 .� ' ry, City Clerk FAX (402) 444-5263 0 4 41F1) FE1 - June 7, 2014 Heather L. Ruthledge Application to be appointed manager of 5531 Hascall Street, Apt#509 present Class "I" Liquor License for Omaha,NE 68106 Spencer's for Steaks and Chops, LLC, dba "Spencer's for Steaks and Chops", 102 South 10th 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 June 21, 2016 . 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, eLidietzw. Buster Brown City Clerk BJB:clj azr, No. �'y Spencer's For Steaks and Chops, LLC, dba "Spencer's For Steaks and Chops", 102 South 10th Street, requests permission to appoint Heather L. Rutledge manager of their present Class "I" Liquor License location. 06-21-16;cj 1 C7 RECEIVED Presented to Cou il: June 21, 2016 - approved o Buster Brown City Clerk