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RES 2015-1613 - Appoint Patrick J Dytrych manager of Target E-wgAlLED STATE OF EBRAWA -y ram * NEBRASKA Limon Rot.COMMISSION „ Gou error' Hobert :RuPe ExectinflePfrector 301 Centennial Mall So y` Floor MANAf ER-ECOMMENDATION Ro,sot 05046 Lincoln,Nel' sica 6$609-5046 Phone(402)4712571 DATE: November 20,.2015 Fax(402)471 $14 c 02)4712474 TFt8#USER 800 3.73522 TIN') web address:http://www.kc v/ TO: = Omaha City Clerk EMAIL: carman.iohnsortecitvofornaha.org MANAGER: Dytrych,Patrick J LICENSEE: STL of Nebraska, Inc.,dba Target Store T-0530 LICENSE#: Class DK-32783 c -- DUE DATE: January 5,2016 —� x , cm co : ["":", : Attached is a copy of a new manager application submitted to Nebraska Liquor Control Ci nmissio►a ;` f f"i Please complete the following to submit your recommendation. Send back to Shannon tho#f at = - Shannon.nvhoffPpebraska.eov or fax to(402)471-2814,with questions call(402)471-2572. APPROVED CCID#1613 DECEMBER 22, 2015 NO LOCAL RECOMMENDATION DENIED COMMENTS: (may attach minutes and/or additional notes) CLERKS SIGNATURE: DATE: Janice M.Wiebnacit Robert Batt Bruce ey Commissioner Chairman 4otitlsalanr An Equal Opportunity Employer f� 530 MANAGER APPLICATION Off u INSERT-Fri 3e NEBRASK i LIQUOR CONTROL COMMISSION E ' 301se CENTENNIAL MALL SOUTH EIVED PO BOX 95046 LINCOLN,NE 68509-5046 V 6 PHONE:(402)471-257 FAX: o )47I- r205 NEBRASKA LIQUOR chsi :rvyv t n . fv CONTROL COMMISSION MUST BE: Citizen of the United States. Include cow of US birth certificate,naturalization, ner or current Unassnort I Nebraska resident. Include copy of voter reeistration.in the State of Nebraska I Fingerprinted. See Form 147 for further information,this form MUST be included with your application. 1 21 years of age or older Name of Corporation/LLC:STL of Nebraska, Inc. Liquor License Number 32783 Class Type r k y DK S (if new application leave blank) Premise Trade Name/DBA:Target Store T-0530 Premise Street Address:4001 N 132nd St City:Omaha County:Douglas 68164 Zip Code: Premise`Phone Number:402-43 -0080 Email address:Liquor.Licensin ©target.corn 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. Click on this link to see authorized individuals. http://www,lcc.ne.eov/liceuse search/licsearch.cgi 01 as bb a+: € rtx& pp. a. k t eF,r 's, • `& 'Y^p :*.;ri ¢ 3 �}g &;,-.. �� 'd,..tea�`..� :.# #3 � Y�..� t+,t,�,.� SA% ..:`k� p (Faxed signatures are acceptable) Y x i Form 103 REV JAN2035 i500025597 oaf d r a iaa1 below'b : ASt . > fi� ELY Last Name:Dytrych First Name:Patrick MI:, 518 So 51st Home Address(include PO Box if applicable): Avenue City:Omaha County:Douglas Zip Code: Home Phone Number:402-558-0876 Business Phone Number:402-201-2658 Social Security Number: Drivers License Number&State: NE Date Of Birth: - - Place Of Birth:Omaha, NE Email address: Liquor.Licensing@target.com ti CEIVED NOV 6 ®YES D NO 2Ql 5 NEBRASKA i J nP CONTROL C{ "�( �N:. �. _ .. .. r-i, • " rune . .° ' �b� �`: � -�� Spouses Last Name: D / 1`�(Ch Catharene MI:A to First Name: Social Security Number: Drivers License Number&State: - - NE Date Of Birth: Place Of Birth:Omaha, NE CITY&_STATE YEAR YEAR CITY&STATE YEAR YEAR FROM TO FROM TO Omaha, NE 1995 Present Omaha, NE 1995 Present Form 103 RV JAN 2015 Post 3of6 _. NAME OF EMPLOYER - 'N E OF SUPERVISOR 3 EL)IONE 11 FROM TQII7 >� 1981 ;Plant Target Corporation Alison Stephen 402-597-3033 1977 1981 LaCasa Pizzaria Nicole Jesse 402-556-6464 1. READ CAREFULLY, ANSWER COMPLETELY AND ACCURATELY, Must be,completed by both applicant and spouse, unless sponse 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&Wu 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. Also list any charges pending at the time of this application. 1f more than one party, please list charges by each individual's name. Q YES Ei 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 RECEIVED \Joy 6 2015 NEBRASKA LIQUOR CONTROL CoMMISSION 2. Have you or your spouse ever been approved or made application for a liquor license in Nebraska or any other state? BYES ONO IF YES, list the name of the premises) 3. Do you, as a manager,qualify under Nebraska Liquor Control Act 053-i31.01)and do you intend to supervise, in person,the management of the business? YES ONO : i e". -40 Form 103 REV JAN 2015 NEeki' �� P ge4of6 -:_*IONTROL COMMISSION 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) Patrick Dytrych Target In-House required alcohol training *For list of NLCC Certified Training Programs see www lcc.ne.nov,traininginfo,htmt Experience: Date of Applicant Name/Job Title Name&Location of Business: Employment: Patrick Dytrych/Store Team Leader Been in role at Target Store T-2383 since 11/2011 RECEIVE * Nov` 6 /rile NEBRASKA LIQUOR - - COI4TROL. COMMISSION 5. Have you enclosed Form 147 regarding fingerprints? YES ONO Form 103 REV JAN 2015 5of6 .max a.« 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 containedtherein 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. Signatu of r Applicant Signal,,, of' t use E E 11) NEBRNA8VSKA6 L2.101111J5 Q1 CONTROL Oi ACKNOWLEDGEMENT State of Nebraska ioN County of tit_5 The foregoing instrument was acknowledged before me this C~# E e, r .C71 by fil date name of person acknowledged Affix Seal * CBM gliARtate of Iamb Notary Public signature tllM41N1F'SMITH MY Comm.bp.,kiy6,2oce 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. a fRIX Form 103 g REV JAN 2015 NEE, .' ,KA, icEt.„ICR Page 6of6 O ?OE COWAESSION '. ; t:Form 1 SPOUSAL AFFIDAVIT OF oss« NON PARTICIPATION INSERT �C IVgb NEBRASJ(ALici CONTROL COMMISSION HECE,IV, E:0 L<$'301 CENTENNIAL MAL O'T'n '` ?# PO Box 95046 �JC KAL QUOLINcoLx,NE 68509 so46 lEBRAS i*RO BRAS A LIQUOR , PliONE:(402)471-2571 ',FAX:,(4(2)471-xsI4 : .►��.nt. .. CO[4TROL COMMISMN m�'1`.'-� `,f S-..:' i a J-«fk Y T 8sir. ;; . a A >~. } - �+ .4 Y ,dn sd ”, -# M ., * 3 t4 a $ 54.• ,s 8 lB f, x 8 $ S Ay dy� �y� d -re,...-idi. '�i ,., � de t C df.r k : i,. ..! 3.A t t „,1 Y lip-,,,..-, �- y�.b ( 'y 4�P e+e � ,. {6 Y @ 5 , z ti� - ,,,,r• .T ,,%,,h,ve,f r. 3m.. , .. nt o ti r ,. i rmt a�s j d i..')s ttt, At i c rr: t a a,t! 4s 5 toe sci . § + '`" k .} 4 3 ,'}e gi B ,„4 Y t i ,A L Ti..,, 6 t �Y. .i * R P 4 nd sz a a t R l i@ a c 9 ¢,� •n ,,,y,,,.' ,, 9sbrt 8 t '' Bl4� 1 m-.,y'� t � ,� �• t*; ryy ,`' ' h�.. to&`. tik- `%€k-+�.h ^3.. - °.Db=:++ - ° ,' ,�..hPt't "'3.` r '`�, t • _ Z....„, Catharene Dytrych Signature of spo as • for waiver Printed name of spouse asking for waiver (Spouse of individual listed below) ` State of e!I1 Ytq County of G t S The foregoing instrument was acknowledged before me this feN be Y"' p�O / by .-liven e fry Ci name of person acknowledgedSate Affix Seat Notary Fu c sMAL ign,, ,' - MiCalivi‘lilaariffibilkitat:MY"I �iq is• ram' Y� a�a�tp ,�� :,"tom �;.:' � ,,.�.�,,,,,,yy��qq h e."'° t a� 5i5 r s t;a watt /,� 4 �, y' e��re�7s�p �Y responsible for ��y, w{ 5 ,,, 'IF 1 �i 1�titA} i 81E 1 }," 5Egfr. � i � E� i r�'^i7 + �e4S Nile.,,: w Y ... ..'.e �. :.:. ,. "` .�.,�. _ x� nt•- -tea Patrick Dytrych Signature of in dual ' vo ved with application Printed name of applying individual (Spouse of ind' idual listed above) State of i/V rZ/q, County of &1c t?Q,,, The foregoing instrument was acknowledged before me this --° v , te ' /5 by P r C . y-4--/-fir C rime of person acknowledged Ofr sea Affix Seal Nta ot y bUc signature m1�SMITH *Ga *t5ltilt ,7fllfd In nano with the ADA,this spousal affidavit of non psrticipation is avaitehie in other formats for persons with disabilities. A ten dad advance period is requested in writing to produce the alternate format. FORM 354178 wed Imes SUBMISSSION OF FINGERPRINTS/ PAYMENT OF FEES TO NSP-CID NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH ' ' T 2 .6 2075 PO BOX 95046 NEE3NASKA Li044 LINCOLN,NE 68509-5046 i PHONE: (402)471-2571 CONTRC *' FAX: (402)471-2814 t - rr NA ebsil e: kN WV\.1C.C.11C.g0‘ El= License#. Applicant Name: STL of Nebraska, Inc. (Corporation,LLC,Partnership or Individual) Trade Name Target Store T-XXXX ,. ,,. ''i, (Doing Busmess As) '01T-' 61i) 761 ..1 ' Liquor.Licen sing @target corn. ' ' Phone Number 5..., l',,,, Contact E-mail Address FoR atilt,. °- ING ' G t ' RINTS AND FEE PAYMENTS: • See New Application Requirement Guide for listing of Fingerprint Requirements, found on our under-Licensing"tab in "Brochures". ' • Fingerprints taken at NSP locations wilt 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. • Fee payment of$28.75 per person must be made directly to the NSF; , You may submit the bplaymeNnt through the NSP PayPort online system at wv,vs,.ne. )0N i o n payable or checks made NSF should be mailed directly to the following address: e t The Nebraska State Patrol—CID Division 3800 NW 12th Street Lincoln,NE 68521 • DO NOT send fee payments to the NLCC—fees MUST be paid directly to NSF; Include a list of names covered by your payment to insure proper application of payment. • 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). • 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. Please complete information on the following pages for EACII e.04-0.,.. s.:-- • 111131111 FORM 147 V EMAR 2015 1500025841 PAGE 1 I.Name: Patrick J Dytrych Title:Store Team Leader How was payment made to NSF? NSP PAYPORT OCHECK SENT TO NSF ike E 2. Name: Title: Nt. How was payment made to NSF? ONSP PAYPORT CHECK SENT TO NItym 71, t CONIp A,)KA 3. Name: Title: How was payment made to NSF? ONSP PAYPORT OCHECK SENT TO 4. Name: Title: How was payment made to NSP? ONSP PAYPORT DCHECKj75 ,01 1;0414tic,1*.:YI? 5, Name: Title: HOW was-payment made to NSP? ENS?PAYPORT OCHECK SENT TO NSF 6, Title: How was payment made to NSF*? ENS? PAYPORT ECHECK SENT TO NSF 7. Name: Title: How was payment made to NSP? ONSP PAYPORT OCHECK SENT TO NSF 8. Name: Title: How was payment made to NSP? ONSP PAYPORT OCHECK SENT TO NSF 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): Rachael Vegas Title. Vice President Signature: (7) .(iktfA,I.,c,,k \1/4.1, Date; 10 FORM 147 REV MAR 2015 PAGE 2 ��N1AA, N CÜgofOmaha, [ebrasIa 7 o ;44 1819 Farnam —Suite LC 1 z 1;4^`41 16t Omaha, Nebraska 681 83-01 1 2 trlh Buster Brown (402) 444-5550 rot, City Clerk FAX (402) 444-5263 o 4 TED FEBR3A December 7, 2015 Patrick J. Dytrych Application to be appointed manager of the 518 South 51 sY Avenue present Package and Catering Liquor License Omaha, NE 68106 locations for STL of Nebraska, Inc. - SEE ATTACHED LIST 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 22, 2015 . 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, r -1; Buster Brown City Clerk BJB:clj PACKAGE WITH CATERING STL OF NEBRASKA, INC. 4001 NO 132ND ST 68164 DBA TARGET STORE T-530 STL OF NEBRASKA, INC. 17810 WEST CENTER ROAD 68130 DBA TARGET STORE T-1777 STL OF NEBRASKA, INC 6636 NORTH 73RD STREET 68122 DBA TARGET STORE T-2010 STL OF NEBRASKA, INC 7200 DODGE STREET 68114 DBA TARGET STORE T-2125 STL OF NEBRASKA, INC 16959 EVANS PLAZA 68116 DBA TARGET STORE T-2326 STL OF NEBRASKA, INC. 12500 "K" PLAZA 68137 DBA TARGET STORE T-2383 E-MAILED TO NLCC VIIII* STATE OF NEBRAsKA iti - Pete Ricketts {' ,, .C'iaeferrror .. blfiBktAsm LiQuo1i 14ro �Y` � N tiy; pp Rupe 301 Centennial Mall Spudi Sift floor MANAGER R CO NDAl iON . a.Box 46- L.ineokr,Nebraska 4509-5096 Phone a 40 l`t 1-2 71 DATE: November 20,2015 Fax(402)47 - or(40 71-2374 IR$U$ER 80083 73 MY) TO: Omaha'City Clerk EMAIL:carman# nsont citvofom a.ort web addr s:IttR•I7w+ +.lcc.ne goy/ MANAGER: Dytrych,Patrick 1 LICENSEE: STL of Nebraska, Inc.,dba Target Store T-1777 1- c.) ..--w.. LICENSE#i~: Class DK-53422 r =- DUE DATE: January 5,2016 -7 ‹ ., co r-- ice' F ! :>. -. , Attached is a copy of a new manager application submitted to Nebraska Liquor ControlCommissikt'. r"'' Please complete the following to submit your recommendation. Send back to Shannon Nyhoff at Shannon.nvhoff@nebraska.ltav or fax to(402)471-2814,with questions call(402)471-2572. X APPROVED CCID#1613 DECEMBER 22 20 15 NO LOCAL RECOMMENDATION DENIED COMMENTS: (may attach minutes and/or additional notes) CLERKS SIGNATURE: 4:0),... -'--......... DATE: ` / Janke M.Withered' Robert Batt Bruce BaileeCom , missioner Chan:u±u,,. Commissioner An Equal Opportunity Employer 1771 MANAGER APPLICATION Office Use INSERT-FORM 3c + i = NEBRASKA LIQUOR CONTROL COMMISSION ��`"` E D 301 CENTENNIAL MALL SOUTH Po BOX 95046 NOV 6 2015 LINCOLN.NE68509-5046 PHONE:(402) z -257l NEBRASKA LIQUOR FAQ:(402)471-2814 website:Lwwtw.lec.ne.gov CONTROL COMMISSION MUST BE: ✓ Citizen of the United States, Include copy of US birth certificate, naturalization paper or current US passport 1 Nebraska resident. Include copy of voter registration in the State of Nebraska I Fingerprinted. See Form 147 for further information,this form MUST be included with your application. 1 21 years of age or older w 5 Name of Corporation/LLC:STL of Nebraska, Inc. Liquor License Number: Class Type D K 53422 (if new application leave blank) Premise Trade Name/DBA:Target Store T-1777 Premise Street Aadress: 17810 W Center.Road city:Omaha County:Douglas Zip code:68130 Premise Phone Number:402-697-4930 Email address: Liquor.Licensing©target.corn 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. Click on this link to see authorized individuals. httn://www.lcc,ne.gov/license search/licsearch.cgi ift4 ++ I (Faxed signatures are acceptable), 111 Form 103 REV JAN2015 1500025593 Pav 2 of 6 REcEi beltt PLEASE �g ' NQV6 ai Last Name: Dytrych First Name:Patrick E3R AsKA 518 So 51st Avend TRoi. o Home Address(include PO Box,if applicable): I City:Omaha County:Douglas glas Zip Code: Home Phone Number: Business Business Phone Number:402-20 -�2 58 Social Security Number: Drivers License Number& State: VE Date Of Birth: Place Of Birth:Crr]aha, Email address: Liquor.Licensing@target.com • 4da YES LINO Spouses Last Name:Dytrych First Name:Catharene MT: _ Social Security Number: Drivers License Number&State: NE Date Of Birth: - --• • —— . Place Of Birth:Omaha, NE YEAR YEAR CITY& STATE CITY&STATE FROM TO YEAR YEAR FROM TO 1 Omaha, NE 1995 Present Omaha, NE 1995 Present Form 103 REV JAN'2015 Paso 3 of 6 YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE FROM TO NUMD `R 1981 Present Target Corporation Alison Stephen 402-597-3033 1977 1981 LaCasa Pizzaria Nicole Jesse 402-556-6464 I. 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 cam. 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. 'Also list any charges pending at the time of this application. If more than one party, please list charges by each individual's name. F3ECEIVED YES p NO If yes,please explain below or attach a separate page. NOV NEBF?ASK Date of Where DescriptigUJlilt I �OR Name of Applicant Conviction Convicted ofjpi �l (mm/yyyy.) (City&State) Charge 2. Have you or your spouse ever been approved or made application for a liquor license in Nebraska or any other state? AYES QNO IF YES, list the name of the premise(s) 3. Do you,as a manager,qualify under Nebraska;Liquor Control Act(§53-I31.01)and do you intend to supervise, in person,the management of the business? YES [_JNp Form 103 REV JAN 2015 N '' iNKA LiQL1OR Page 4 of 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: ti Applicant Name ra (�DateYYYY) Name of program(attach copy of course completion certificate) Patrick Dytrych Target In-House required alcohol training RECEIVED NOV 6 2015 NEBRASKA CONT 'OL �l C 11 iS� I�+N *For list of NLCC Certified Training Programs see www.lcc.ne.govttraininginflo.html Experience: Date of Applicant Name/Job Title Em to Name&Location of Business: P yment: Patrick Dytrych/Store Team Leader Been in role at Target Store T-2383 since 11/2011 5. Have you enclosed Form 147 regarding fingerprints? AYES ONO Form 103 REV JAN 2015 Page S 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 i a •� _: ,' ed in this application, is subject to cancellation if the information contained herein is income e' 1 .e 1 e, or fraudulent. NOV015 NEBRASKA L IQ FOR t NT 01 COMmissioN Citfi Signatu of an er Applicant Signa.u of use ACKNOWLEDGEMENT State of Nebraska County of I)c4,5/41_5 The foregoing instrument was acknowledged before me this c) 1 date name of person aclmowledged Affix Seal Notary Public signature . TIMOTHY SIM H ?Ay Comm, tlra 20140 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 z g REV JAN 2015 `d t"'t 3...6 o 1 .Page6of6 47;0 NT L COMMISSION SPOUSAL AFFIDAVIT OF NON PARTICIPATION INSERT NEBRASKA LIQUOR CONTROL COMMISSION t� £V 301 CENTENNIAL MALL soon{ PO BOX 95046 LINCOLN,NE b8509-5046 PHONE;(402)471-251 t � 4 1 �. FAX:(4ox)47t-28I4 .c ri'r. W. OMMIS t N Website: www.1.7„ene.gov Y. { rvm Ill i `ex a .: Ae" `Xt. ? = a ".� 3 a , ,.c vd ga t ,t6 x - n. a5 „ ss . a i s* k t a� n� 8 € ��' r t i { G *I l :', �IX e,hY,e.; ; j { ps F k' �s -y # 9S ° F Y}, i:l A$ ,• 2A S }€ F 1 4Y Z 5k V4¢ "a I. ( .t 4 t- ..- s A q x e d s dd,,- '.. F ;; ,, -, pt m .:€ t k Fy -. � t e e . x a�ix'-' e' � a c - e' - 4s � a o '3� a.- �" ,, y$ Wa � � ; c s n % s 3 ("- "� -r t a r xi. "� - -. sle E ' / _°. .. ./3-t-ivit Catharene Dytrych Signature of askft. far waiver Printed name of spouse asking for waiver (Spouse of individual,�l-isted below) / �i Yt State of ' 2t County of (y1(..3 The foregoing instrument was acknowledged before me this G ►^ t � �5 by - ,mere rYC,l% " Sate name of person acknowledged f�" Ot Affix Seal avitimmyaitichiss Notary Pu c signature Tl�bi'fil�►salmi. .s *Cam exVkirkane _ ° # p i r '' 6 � I undo rett�ati a 'ui's' 6 F X.' 1 6! @ 1L- € !,S b 1 x }� 5?. f�t """"�''+� € ✓` ,,., � F .,,�� ° a z ;1 s: i <, � °t fit ,� 4� � a;.+ ��', - , �# F ' > 4 Patrick Dytrych Signature of i + dual ' vo ved with application Printed name of applying individual (Spouse of intl.,idual listed above) State off /IfCounty of 1)c= ict j The foregoing instrument was acknowledged before me this Qc&r aC) /5 by Pct Il c- k -4-ky C t1 S name of person acknowledged Affix Seal ":A_ SIMI Notary is signature MyI' In compliance with the ADA,this spoucal affidavit of non participation is available in other formats for persons with disabilities, A ten day advance period is requested in writing to produce the alternate format. FORM 3$-4178 Revised 1120011 SUBMISSSION OF FINGERPRINTS, PAYMENT OF FEES TO NSP-CID tE ../V% D NEI3RASKA LIQUOR CONTROL COMMISSION NEE Ili'A'SKA 41.:1115 14134V 301 CENTENNIAL MALL SOUTH 2 6 PO BOX 95046 LINCOLN,NE 68509-5046 PHONE: (402)471-2571 CON rFc'cliffr,z,,,, FAX:(402)471-2814 Website: ww"j".ne.gov License#: Applicant Name: STL of Nebraska, Inc. (ComoratioflLtphip or Trade Name: Target Store T-AAA4 0' Mon*Business As) f414' 61i)761 - 1015 Phone Nitmber Liquor.Licensing@target corn Contact E-mail Address DIIIECTION FOR SUBMITTING LAPIUNTS AND FEE PAYMENTS: • See New Application Requirement Guide for listing of Fingerprint Requirements, found on our ‘k,ehsite under"Licensing"tab in "Brochures". * 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. • Fee payment of$28.75 per person must be made directly to the NSP; You may submit the payment through the NSP PayPort online system at wv‘A.oe.goN Lto nsp 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 e 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. • 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). • 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. Please complete information on the following pages for EACH 710,...„- - • 11111111111111 FORM 147 EV MAR 2015 1500025841 PAGE 1 l.Name: Patrick J Dytrych Store Team Title: Leader How was payment made to NSF? NSP PAYPORT OCHECK SENT TO NSP 2. Name: Title: How was payment made to NSP? ONSP PAYPORT OC:HECK SENT'..NSF', E 3. Name: : } How was payment made to NSP? ONSP PAYPORT OCHECK SENT TO 4. Name: Title:_ ¢a _ How was payment made to NSP? ENSP PAYPORT OCHECK S , 5. Name 44EI � etiE . s; Title: to;NSP. ONSP PAYPORT OCHECK SENT TO NSP 6. Nam, Title: How was payment made to NSP? ONSP PAYPORT OCHECK SENT TO NSP 7. Name: Title: How was payment made to NSF? ❑NSP PAYPORT OCHECK SENT TO NSP 8. Name: Title: How was payment made to NSP? ONSP PAYPORT OCHECK SENT TO NSP 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): Rachael Vegas Title: Vice President Signature: ( fe,p,,Q Q Date le/6 J !5" FORM 147 REV MAR 2015 PAGE 2 o HA, N�� CitgofOmalw artJ Arre , 1819 Farnam — Suite LC 1 Omaha, Nebraska 68183-0112 ngr Buster Brown (402) 444-5550 vo ry City Clerk FAX (402) 444-5263 pq " TFD FEBR�' December 7, 2015 STL of Nebraska, Inc. Application to appoint Patrick J. Dytrych Dba"Target Store T-1777" manager of your present Package and 17810 West Center Road Catering Liquor License location Omaha,NE 68130 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 22, 2015 . 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, �.d Buster Brown City Clerk BJB:clj City of Omaha, NebraskaAllikk,or4 1819 Farnam — Suite LC 1 n � t r Omaha, Nebraska 68183-0112 0 Buster Brown (402) 444-5550 7,35 City Clerk FAX (402) 444-5263 0 4� rFD FEBR‘A December 7, 2015 Patrick J. Dytrych Application to be appointed manager of the 518 South 51S`Avenue present Package and Catering Liquor License Omaha,NE 68106 locations for STL of Nebraska, Inc. - SEE ATTACHED LIST 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 22, 2015 . 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, A41-41 Buster Brown City Clerk BJB:clj PACKAGE WITH CATERING STL OF NEBRASKA, INC. 4001 NO 132ND ST 68164 DBA TARGET STORE T-530 STL OF NEBRASKA, INC. 17810 WEST CENTER ROAD 68130 DBA TARGET STORE T-1777 STL OF NEBRASKA, INC 6636 NORTH 73RD STREET 68122 DBA TARGET STORE T-2010 STL OF NEBRASKA, INC 7200 DODGE STREET 68114 DBA TARGET STORE T-2125 STL OF NEBRASKA, INC 16959 EVANS PLAZA 68116 DBA TARGET STORE T-2326 STL OF NEBRASKA, INC. 12500 "K" PLAZA 68137 DBA TARGET STORE T-2383 E-lviAlt,En'I'n NL,CC o4�4tkr� 4,4 . � STATE.OF NEBRASKA Pete Ricketts NEBRASKALill/um.tbratKi:OomikiessicoN Governor Hit .u *t &mat.Dimetor 301 Cent ial South,5th Floor MANAGER RECOMMENDATION ' Phi.Box 95046 Lincoln,Nebra 68509-5046 Phone140 j 471-2571 DATE: November 20,2015 Fax(402) 12814 or(402)471 374 IRS USER 800 833-7352(TTY) web address:http://www.Icc.ne.gov/ TO: Omaha City Clerk EMAIL:carman iohnson(Mcitvofomaha.org MANAGER: Dytrych,Patrick! LICENSEE STL of Nebraska,Inc.,dba Target Store T-2010 F• r-) LICENSE# Class DK-75369 r ri cc,DUE DATE: January 5, 2015 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 Shannon Nyhoff at Shannon.nyhof gonebras a.eov or fax to(402)471-2814,with questions call(402)471-2572. APPROVED CCID#1613 DECEMBER 22,2015 NO LOCAL RECOMMENDATION DENIED COMMENTS: (may attach minutes and/or additional notes) CLERKS SIGNATURE: ii,e0 ,//f70;•- /017(0..14-- fie'M.Wiebuech- Robert BAK Bruce Bailey ChatR Comm issioner An Equal Opportunity Depioyer 020, c) MANAGER APPLICATION Office Use INSERT-FORM 3c RECEIVED NEBRASKALIQUOR CONTROL COMMISSl©N 301 CENTENNIAL MALL SOUTH NEBRASKA PO BOX 95046 NOV 2015 LINCOLN,NE 68509-5046 PHONE.(402)471-2571LIQUOR FAX:(402)471-2814 CONTROL coA giu were:W WW.lce,ne.gov MUST BE: Citizen of the United States. Include copy of US birth certil"icate..naturalizationt naner=or current US passport ✓ Nebraska resident. Include copy of voter registration in the State$f Nebraska I Fingerprinted. See Form 147 for further information,this form MUST be included with your application. ( 21 years of age or older STL of Nebraska, Inc. Name of Corporation/I.T,C: Liquor License Number: 75369 Class Type DK yp (if new application leave blank) Premise Trade Nameii)BA:Target Store T-2010 Premise Street Address:6636 N 73rd Street City:Omaha County:Douglas zip Code:68122 Premise Phone Number:402- 73-2220 Email iddress: Liquor.LIO sing p@target.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. Click on this link to see authorized individuals. http://ww .lcc.ne.aov/license search/licsearpch.cgi �5 1 s `�i • 7i �, x Y[ ,�, al" st'at �p oys �� t e "t ..:. - Yss :sa... vr- :n-ara °�... `�... r� �s '�?' i - ` c'F.-"�._ d: (Faxed signatures are acceptable) Ilii ��. i Form 103 ,i'# 1! R3AN2015 1500025592 Page 2 of 6 NOV 6 2j15 Last Name:Dytrych First Name:Patrick 1: 518 So 51 st A venuecoNm 'm ss' N Home Address(include PO Box if applicable): � fll � City:Omaha County:Douglas Zip Code: 4025588 Home Phone Number: - �'� Business Phone Number:402 � ' _` i NE Social Security Number: --- Drivers License Number&State: Date Of Birth: - -• . -- . Place Of Birth:Orrlaha, NE Email address:Liquor.Ltcens►1ng© rget.COm -# M es M YES [Q NO •..�„ .. we.' '",�� e 7PE sx..� .... � u�4qU. ;',v Spouses Last Name:Dytrych First N Catharene ame: MI: Social Security Number: - - - Drivers License Number&State: E Date Of Birth: - --- • - - - Place Of Birth:Omaha, NE YEAR YEAR CITY& STATE CITY& STATE FROM TO YEAR YEAR FROM . 'O Omaha, NE 1995 Present Omaha, NE 1995 Present Form 103 REV MN 2415 'age3o'6 YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPhNE FROM TO NUIVIItElt 1981 Present Target Corporation Alison Stephen 402-597-3033 1977 1981 : LaCasa Pizzeria Nicole Jesse 402 556-4 4 i. 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 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. Also list any charges pending at the time of this application. If more than one , please list charges by each individual's name. ► Ei YES Q NO NOV 6 2015 If yes,please explain below or attach a separate page. EBFIASKA LIQUOR Date of Where Descripti TRt L COMMISSION Name of Applicant Conviction Convicted of Disposition (mmlyyyy) (City&State) Charge 2. Have you or your spouse ever been approved or made application for a liquor license in Nebraska or any other state? ©YES DNO 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? "EYES ONO trlECT'IVFD -1, 6 L t Form 103 REV 3AN2015 s" LIQUOR rya°rd CON° *R L ' i i 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) (rntniyy ) Patrick DYtrych Target to-House required alcohol training I op CONTFict *For list of NLCC Certified Training Programs see www.lcc.ne.eov.traininginfo.httnl Cperence; Applicant Name/Job Title Date of Name&Location of Business: Employment: Patrick Dytryc h/Stare Team Leader Been in role at Target Store T-2383 since 11/2011 5. Have you enclosed Form 147 regarding fingerprints? NOYES LINO Form 103 REV MN 2013 Pages of 6 r µ 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 applicants) 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 informs n submitted in this application, is subject to cancellation if the infolation contained herein is incomple e V. : , i fraudulent. O 6 ( t t� +� � SiON Sigrnatu of er Applicant Signa of use ACKNOWLEDGEMENT State of Nebraska County of t45/&.$ The foregoing instrument was acknowledged before me this c. :C1 d'c..-!slier , sate s by til a� he Dy name of person acknowledged Affix SealGOIERAL$1 ' Notary Public signature ' TiIlIilOTt#1rSNaT11 MY cnm.Exp.July8.2018 In compliance with the ADA,this application is available in other formats for persons with disabilities. A ten day advance period is required in writing to produce the alternate format. ss .; Form 103 REV JAN 20i5 �' L1� Page 6ofs CONTROLCOMMISSIC)14 SPOUSAL AFFIDAVIT OF omce Use NON PARTICIPATION INSERTRECEIVED NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH `I PO BOX 95046 LINCOLN,NE PHONE (401)467102371 � ALIQUOR FAX:{402)471-2814 CONTROL COMM1SS ON website: www.lcane.gov '! a, t1 aC C e, ..t-t: s 'i ,._e-O a1 aexD,r.y 5"o$�- or naw ..' a e ..- - .A . :ea a ra i • 6 3 r e �- 8 x S ! as. ta y � t :4,:,?d�' ' � � � � 4' @ vz: 16 " , . a '9t :' r ` i y& i wx1 4 m t1w t °r; r { g qT j! a a & em ` 6 tat 3+^ " s p 7 4{? + '':!' € s � a % t £ e2M & Tt<a1Y ; a€ , b# ' ry `a. 1 ,r.' ; R e � . 0 x e . �•.f�, ia� e a # a a a s � are a zx is a �P e� ➢6` 'Yc : ; F :b x � � w i ,ii eF P 18 A 5r F r r, , G Its s l+` �^, e, _ 1 ' #:.'JJ k,„. ._ ,4*A.,,m:r . r 4 a .:i'`,. -fi 4 ,,A a sa.,Ig ,e ', m r*,, °a , 04K ..ia,. a+ ,f ti:< j� ,t/^�g� N R NEBRA�7� Ed i Catharene Dytrych � L 3f ° �lN i Signature of spoask' for waiver Printed name of spouse asking for waiver (Spouse of individual listed below) .J1'�i� State of /II . If County of Duji es The foregoing instrument was acknowledged before me a this G d t 0by C n E - -ft"y name of person acknowledged )40Affix Seal gam, iotika- NOS signature 6E !won* Ill of IV Comm eiP.Aktin• ''..id, a x Bail wi , : a . 7 #1COrti isslon m: t •. ;a i:„ t ahquorlicense;, ' • Patrick Dytrych Signature of in ual ' vo ved with application Printed name of applying individual (Spouse of incl. idual listed above) State of County of e ?'S The foregoing instrument was acknowledged before me this {.•C-Ad e -° :. t C t�` byPatrick i r C flame of person acknowledged Affix Seal l 11911146*IS* Notary is signature i 31fgal In compliance with the ADA,this spousal affidavit of non participation is available in other formats for persons with disabilities. A ten day advance period is requested in writing to produce the alternate format. FORM 35-4178 Refused 1/2008 SUBMISSSION OF FINGERPRINTS/ PAYMENT OF FEES TO NSP-CID Fisn /wt. v L.; NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH i) 2 6 PO BOX 95046 LINCOLN,NE 68509-5046 NEi3F?ASKA Li .1141 PHONE- (402)471-2571 CONTrIcof -11 FAX:(402)471-2814 tk obsite: ‘NIA License#: Applicant Name: STL of Nebraska, Inc. (Corporation,LLC,Partnership or Individual) Trade Name: Target Store T-XXXX .1 usiness As) 6-6) 761 „ffis„ Phone Number 1,„ Liquor.Licensingata t rge .com Contact E-mail Address ING 01OR siTB vaTT RPRINTS AND FEE PAYMENTS: • See New Application Requirement Guide for listing of Fingerprint Requirements, found on our v‘oh,,ite under"Licensing"tab in -Brochures". • 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. • Fee payment of$28.75 per person must be made directly to the NSF; You may submit the payment through the NSP PayPort online system at i8s.N. .11e401 1W.0 nsp or checks made payable to NSP should be mailed directly to the following address: The Nebraska State Patrol—CID Division 3800 NW 126 Street Lincoln, NE 68521 • DO NOT send fee payments to the NLCC—fees MUST be paid directly to NSF; Include a list of names covered by your payment to insure proper application qf payment. • 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). • 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. Please complete information on the following pages for EACH no.- • FORM 147 EV MAR 2015 1500025841 PAGE 1 Patrick J Dytrych Store Team Leader I.Name: lit How was payment made to NSF? NSP PAYPORT OCHECK SENT TO NSF R pi 2. Name: Title: How was payment made to NSP? DNSP PAYPORT CCHECK SENT TO NV0 tvEEQA,'SKA CONTROI Okitto 3. Name: Title: How was payment made to NSP? ONSP PAYPORT OCHECK SENT TO - ' / 4. Name: Title: How was payment made to NSP? ONSP PAYPORT OCHECK(S ftSr,NAE. 't4 04. r, QUo 0 kis. 5. Name: Title: S/OV nOvi WaS'".,rtn'ent to NSF? ONSP PAYPORT DCHECK SENT TO NSF a. Title: Ho R was payment made to NSF? ONSP PAYPORT OCHECK SENT TO NSP 7. Name: Title: How was payment made to NSP? ONSP PAYPORT OCHECK SENT TO NSF 8, Name: Title: How was payment made to NSF? ONSP PAYPORT OCHECK SENT TO NSF 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): Rachael Vegas Title: Aire President Signature: 1U4?,jbag Date: 11) I FORM 147 REV MAR 2015 PAGE 2 City ofOma/1a OriAHA N U 1819 Farnam — Suite LC 1 x is;"1 ^iki r n Omaha, Nebraska 68183-0112 o v- - Buster Brown (402) 444-5550 0� 1'` ``'`� ry "' City Clerk FAX (402) 444-5263 o 4 -4 to FEI33° ' December 7, 2015 STL of Nebraska, Inc. Application to appoint Patrick J. Dytrych Dba"Target Store T-2010" manager of your present Package and 6636 North 73`1 Street Catering Liquor License location Omaha, NE 68122 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 22, 2015 . 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, X --.....,,,,,. Buster Brown City Clerk BJB:clj City �N►Aliq N ofWebra4a o4 �� `;c; 1819 Farnam — Suite LC 1 z ► �,�C ''*1 # Omaha, Nebraska 681 83-01 1 2 Buster Browno�, ,�., (402) 444-5550 ry, 4p City Clerk FAX (402) 444-5263 o FD FEBR�A December 7, 2015 Patrick J. Dytrych Application to be appointed manager of the 518 South 515t Avenue present Package and Catering Liquor License Omaha, NE 68106 locations for STL of Nebraska, Inc. - SEE ATTACHED LIST 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 22, 2015 . 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, 4'//' e.„4:5") Buster Brown City Clerk BJB:clj PACKAGE WITH CATERING STL OF NEBRASKA, INC. 4001 NO 132ND ST 68164 DBA TARGET STORE T-530 STL OF NEBRASKA, INC. 17810 WEST CENTER ROAD 68130 DBA TARGET STORE T-1777 STL OF NEBRASKA, INC 6636 NORTH 73RD STREET 68122 DBA TARGET STORE T-2010 STL OF NEBRASKA, INC 7200 DODGE STREET 68114 DBA TARGET STORE T-2125 STL OF NEBRASKA, INC 16959 EVANS PLAZA 68116 DBA TARGET STORE T-2326 STL OF NEBRASKA, INC. 12500 "K" PLAZA 68137 DBA TARGET STORE T-2383 51 E-MAILEDTONI,CC12T2,' r/ • STATE OF NEBRASKA 4 Pete Rlicisetts. NEBRASKA,LIQUOR CONri'JtUUL,"��SSlUN Governor Hebert 8,-Rupe 4,47, Executive Director 301 Centennial Man South,5th Moor MANAGER RECOMMENDATION P.o,Box 950 Lincoln",Nebraska 6 09-5046 Phone 471-2571 DATE: November 20, 2015 Fax(402)471-2814 or 402)47.1,2374 IRS USER 800'833-735 (TTY) web address:itttp://wwwlecne.goe, TO: Omaha City Clerk : EMAIL.carman.iohnsonc citvofornaha.org MANAGER: Dytrych,Patrick) LICENSEE: STL of Nebraska, Inc.,dba Target Store T-2125 LICENSE#: Class DK-75370 77 rr1 — DUE DATE: January 5,2016 I r 4) 7",y 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 Shannon Nyhoff at Shannon.nvhoffeonebraskagov or fax to(402)471-2814,with questions call(402)471-2572, I\ APPROVED CCID#1613 DECEMBER 22, 2015 NO LOCAL RECOMMENDATION DENIED COMMENTS: (may attach minutes and/or additional notes) CLERKS SIGNATURE: n DATE: � /A3// Jana+ M.Wiebusch Robert Hatt Commissioner Chairman Brumes_' Commissioner An Equal Opportunity Employer MANAGER APPLICATION office use INSERT-FORM 3c NE'BRA KA LIQUOR CONTROL COMMISSION RECEIVED 301 CENTENNIAL MALL SOUTH PO BOX 95046 U COLN,NE 68509-5046 i PHONE:(402)471-2571 FAX:(402)471-2814E + Website:www.lcc.ne.gow° MUST BE: • Citizen of the United States. Include copy of US birth certificate,naturalization parer or current US passport ✓ Nebraska resident. Include copy of voter registration in the State of Nebraska ✓ Fingerprinted. See Form 147 for further information,this form MUST be included with your application. ✓ 21 years of age or older - b Name of Cor ration/LLC:STL of Nebraska, Inc. Liquor License Number: 75370 Class Type yp DK Of new application leave blank) Premise Trade Name/DBA:Target Store T-t2' 1 25 Premise Street Address:7200 Dodge Street City: Omaha County:Douglas Zip Code:6$114 Premise Phone Number:402 gg' $0 Emailaddress: Liqu©r.Licensing©target,com The individual whose name is listed as a corporate officer or managing member as reported on insert form 3a or 3b or listed with the Commission. Click on this Iink to see authorized individuals. http://www.lce.ne.govilicense search/iieseareh e i y 1!µ�' 1a_ ,? k......h &7 „, 6p `° `.Fv�wy� "y$,A q ' (Faxed signatures are acceptable) i� Fonn 103 1500025594 REV JAAN 2015 Page 2 of 6 PLEASE PRi ct CLtV ECE IVE Last Name: Dytrych First Name:Patrick Home Address(include PO Box if applicable): 5' So 51 st Avenu 1� �C3�. C �lMISIUN City:Omaha County:Douglas Zip Code: T Home Phone Number:4�2 Business Phone Number: ' 2658 Social Security Number: Drivers License Number&State: E Date Of Birth: - Place Of Birth:Omaha, NE Email address:Liquor.Licensing©target:com x, is 4'+ ,r -w Ez mror """ ,•. - ©YES Q NO Spouses Last Name:Dytrych First Name:Catharene :A MI: Social Security Number: - - Drivers License Number&State. NE Date Of Birth: ^ Place Of Birth:Omaha, NE ,$y 4 •' 9 y; 0'i .tr .,r,a: >�, aagt .€ "x'`��`Y * 4. ePt ,,. :x•`x", • CITY & STATE YEAR. YEAR CITY& STATE YEAR YEAR FROM TO FROM TO Omaha, NE 1995 Present Omaha, NE 1995 Present Form 103 REV JAN 2015 Page 3 of6. YEAR NAME OF EMPLOYER. NAME OF SUPERVISOR TELEPHONE PROM TO 1981 Present Target Corporation Alison Stephen 4O2- 97-033 1977 1981 LaCasa Pizzaria Nicole Jesse 402-55843464 i. 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 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 RECE1V5 conviction or plea. Also list any charges pending at the tune of this application. If more than one list charges by each individual's name. El YES Q NO NOV6 21115 If yes,please explain below or attach a separate page. NEBRASKA LIQUOR Date of Where Description t. Ct +tlllll N Name of Applicant Conviction Convicted of Disposition (in f'yyy) (City&State) _ Charge 2. Have you or your spouse ever been approved or made application for a liquor license in Nebraska or any other state? ®YES' ONO 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? DIVES ONO 103 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 (may) Name of program(attach copy of course completion certificate) Patrick Dytrych Target In-House required alcohol training '% 201 ASA 6 }P. c4:1;4:TBRRO ioN *For list of NLCC Certified Training Programs see www.lce.ne.gov/traininginfo:httni Experience: Date of Applicant Name/Job Title Name&Location of Business: Employment: Patrick Dytrych/Store Team Leader Been in role at Target Store T-23$3 since 11/2011 5. Have you enclosed Form 147 regarding fingerprints? 'EYES ONO Form 103 REV JAN 2015 Page 5 of 6 RECEIVE* � .r The above individual(s), being first duly sworn upon oath, deposes and == ti it's.."1.: -'! the applicant and/or spouse of applicant who makes the above and foregoing apOIWAN. c' 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. Signatu of n er Applicant Signa of se ACKNOWLEDGEMENT State of Nebraska County of Uc4 /.s The foregoing instrument was acknowledged before me this Q.C--2 1 by j ail r ,tee r r+,2 y+r:yc4 date name of person acknowledged w Affix Seal COWL NARY**uf Ikluvara Notary Public Signature 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. 6 Form 103 REV JAN 2015 LIQUOR Page6of6 CONTR OL COMMISSION Print Form SPOUSAL AFFIDAVIT OF ilErvez W NON PARTICIPATION INSERT NOVNEBRASKA LIQUOR CONTROL COMMISSION () 1'1 , - j L„,1c 301 CENTENNIAL MALL SOUTH PO BOX95046 - N RASA L • r.- LINGOLN,NE sgso9-sons ,« # SKALIQUOR PHONE:00)471-2571 ONROLFAX:(402)471-2814 + Website: ww w.lc ne goy x m 14 ,1. # —1,41; # 1 #'- ':! 10 8 #§ }'73 E #, i $ ifM ## t' € tt. i! 'Gi i, t! x � � #}, N Pi'E� W-.ayt Y 4 Y i ,d,fl�0 cV k $ 6 � :�� t f '2k @ S k�f If, •i� ➢ • ; L A x F::4 #*. li 4t e lfr:% ry `� ° k, Y �a 1 fi f,k.rg`c.;, 'S hat. a . a'' {t *t , n r, c ,, d - aq x4 c0 tt a x, s to if Mc q, [ oa e is a # * t rot + ^+ 4, S 6 t i i k t f d t y t- Pf 4Zd d C , t 4 6 i'. 6 C S y '.\* 'a0 a}E+ m ...:.s�� +k: '�';,e� '.'-it.:-. • Fi,.s +wit y#tsit � � u ��a `i 4n '�� x .s.,• ,� � `'�;i� �.y,�� `� `�.. _ .� 'S a ,,s Y 5 � bE## � k �� "� �� r,� _ ' ��."';'a ` "� ^•`� x �$� r ... 'i Catharene Dytrych Signature of spou as ' for waiver Printed name of spouse asking for waiver (Spouse of individual listed below) State of g County of 1-f,9 i('S The foregoing instrument was acknowledged before me this ,C .rD ao /5 by -?4, 'rt e ry c,4, Late name of person acknowledged ' ' , ',', -,204,-44.. Affix Seali[s 11g11 t, etMak Notate signature 11fA4TH1t 8i *Comm Op.Aitia,am 0wled c n " 1 , is`iedialrvi I wide s nd t*iy S S andhl o tpon i e for 1 Y 4 ! R. #[ #5 i e 7 complfance coisi at,,w .," ai, t'.r t t . 1 r .h he' ootte % Mdual .**141,4104053Wi2 )) Patrick Dytrych Signature of in dual vo ved with f----application Printed name of applying individual (Spouse of inJd' idual listed above) State of,Ar4, 4 County of / 149? e .� The foregoing instrument was acknowledged before me this O -AdDer c f a0 is- by Piz c k t -4 C L, name of person acknowledged TT1. esii.. y uosastiosia / iicsignature M in compliance with the ADA,this spousal affidavit of non participation is available in other formats for persons with disabilities. A ten day advance period is requested in writing to produce the alternate format. FORM 35-4178 Revised 1/2005 , SUBMISSSION OF FINGERPRINTS/ PAYMENT OF FEES TO NSF-CID RE: lii, a NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH , PO BOX 95046 LrNcoLN,NE 68509-5046 NEEI;;As ,—A PHONE: (402)471-2571 CONTE1 FAX:(402)471-2814 ...,:s website: "NA vc.lcc.ne.gox License#: Applicant Name: STL of Nebraska, Inc. (Corporation,LLC,Partnership or Individual) Trade Name: Target Store T-XXX4.‘ Mtatn Business As) .t' ' 1 6101 761 — 1015 ' Phone Number ''''''4%, ' ,i Liquor.Licensing@target corrl ftvi'l Contact E-mail Addres 13 II OR SUBvtipripriING FIN, ,,,...,,-nr2 PUERPRINTS AND FEE PAYMENTS: • See New Application Requiretnent Guide for listing of Fingerprint Requirements, found on our Under"Licensing"tab in "Brochures". • 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. • Fee payment of$28.75 per person must be made directly to the NSP; You may submit the payment through the NSP PayPort online system at VV4t Vs„ne.go% utt,nsp 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 • 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 qfpdvinent. • 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). • 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. Please complete information on the following pages for EACH 101111111111 FORM 147 MAR 2015 1500025841 PAGE 1 _ — ____.. $ I Name. Patrick J Dytrych Store Team Leader . Tit How was payment made to NSP? giNSP PAYPORT OCHECK SENT TO NSP RET:Ez 2. Title:___ How was payment made to NSF? DNSP PAYPORT CCHECK SENT TO NV' "E6A 40k., Jr 3. Name: Title: How was payment made to NSP? DNSP PAYPORT OCHECK SENT TO,SP r-17(‘Z 4. Name: Title:__ How was payment made to NSP? DNSP PAYPORT DCHECK.&_. P''•418.?„, rlfrv, k,A, 5. Name: Title: /0v How was payment NSP? ONSP PAYPORT OCHECK SENT TO NSF .64 Nane; Title: HOW was payment made to NSP? ONSP PAYPORT DCHECK SENT TO NSP 7. Name: Title: How was payment made to NSF? EJNSP PAYPORT E3CHECK SENT TO NSP 8. Name: Title: How was payment made to NSP? DNSP PAYPORT DCHECK SENT TO NSF 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): Rachael Vegas Title. vire President Signature: 1.AtOkr.,4,44) Date. fob. //Se FORM 147 REV MAR 2015 PAGE 2 CLI!! of Omaha Nebraska OZv1AHA N� V Paii. 9 1819 Farnam — Suite LC 1 'Ill X LI I, Omaha, Nebraska 681 83-01 1 2 �W , ril Oar .:.yam"!', ;v4,0 Buster Brown (402) 444-5550 �� u ry City Clerk FAX (402) 444-5263 o 4� 9T4A FEB0r December 7, 2015 ,STL of Nebraska, Inc. Application to appoint Patrick J. Dytrych Dba"Target Store T-2125" manager of your present Package and 7200 Dodge Street Catering Liquor 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 December 22, 2015 . 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, Buster Brown City Clerk BJB:clj City of l WJe brasNebraska ON1AI-iA,/N� 1819 Farnam — Suite LC 1 ' pr, r ��r� itt Omaha, Nebraska 681 83-01 1 2 Cog' v.N r Buster Brown (402) 444-5550 �; City Clerk FAX (402) 444-5263 0� 9T�D FEBR"A December 7, 2015 Patrick J. Dytrych Application to be appointed manager of the 518 South 51 St Avenue present Package and Catering Liquor License Omaha, NE 68106 locations for STL of Nebraska, Inc. - SEE ATTACHED LIST 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 22, 2015 . 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, Buster Brown City Clerk BJB:clj PACKAGE WITH CATERING STL OF NEBRASKA, INC. 4001 NO 132ND ST 68164 DBA TARGET STORE T-530 STL OF NEBRASKA, INC. 17810 WEST CENTER ROAD 68130 DBA TARGET STORE T-1777 STL OF NEBRASKA, INC 6636 NORTH 73RD STREET 68122 DBA TARGET STORE T-2010 STL OF NEBRASKA, INC 7200 DODGE STREET 68114 DBA TARGET STORE T-2125 STL OF NEBRASKA, INC 16959 EVANS PLAZA 68116 DBA TARGET STORE T-2326 STL OF NEBRASKA, INC. 12500 "K" PLAZA 68137 DBA TARGET STORE T-2383 FAA AILED TO NLCCSTATE „ OF NEBRASKA ¢* Pete N SKA LIQUORCQi rnioL C tsax rW Gouetrr Hobert B:Rupe 4, a+ y p Executioe Director 301 Centennial Mall South,'5th Moor MANAGER E OMM NDATION 8ox 95046 Doha,Nebraska f 8 6046 Phone(402Z 471-25571 DATE: November 20,2015 Fax(402)4 71-2814 or(402)471<2374 TRS USER 800 833-73552(MY) i TO: Omaha City Clerk EMAIL:carrnan.iohnsontacitvof$maha,orgweb :http jjwwwicx. e,govl MANAGER: Dytrych, Patrick 1 ry LICENSEE: STL of Nebraska, Inc.,dba Target Store T-2326 LICENSE#: Class DK-77984 cxi rr DUE DATE: -_. January-5,201fi rr. 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 Shannon Nyhoff at Shanrnon.nyhoff@nebraska.Rov or fax to(402)471-2814,with questions call(402)471- 572, APPROVED CCID#1613 DECEMBER 22 2015 NO LOCAL RECOMMENDATION DENIED COMMENTS. (may attach minutes and/or r additional notes). CLERKS SIGNATURE: Janice M.IliViebusch Robert Batt Bruce Bailey Commissioner Chairman Commissioner An Equal Opportunity Employer 23.7c, . MANAGER APPLICATION Office Use INSERT-FORM 3c RECEIVED NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH NOV 6 2015 P'0-BOX 95046 LINCOLN,NE 68509-5046NEBRASKA LIQUOR PHONE:(402)471-2571 CONTROL COMMISSION PAX:(402)471-2814 Website:w .lec.ne.gcv MUST RE: Citizen of the United States, include copy of US birth certificate,natura!izatigin paver or current US passport Nebraska resident. Include cony gf voter registration in the State of Nebraska 1 Fingerprinted. See Form 147 for further information,this form MUST be included with your application. 21 years of age or older e arcaraac:STL of Nebraska, Inc: Liquor License Number: 77984 Class Type DK cif new application leave blank) Premise Trade Name/DBA:Target Store T-2326 Premise Street Address: 16959 Evans Plaza City:Omaha county:Douglas Zip code:68116 402 Premise Phone.Number: -g7a- 666 Email address:Liquor.Licensing©target*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. Click on this link to see authorized individuals. http:llwiww.lcc.ne.govllicensc search/licsearch.ct i 1 � s ��yy +f[.{+ hY'w 21 r a h. 'E` s 4 Y Y v&9 gY 5 P Lg .. .^s...l: we ...•3 ..r r. .v r :,:rv�$�f xY.r',i: �` '�.. .x: `x:.4. .,.'',.�� Y (Faxed signatures-are acceptable) (I ` form 103 M Ii' REV JAN 2015 Page 2of6 1500025230 'r " CLEARLY7RAE:6 Last Name:D . t ch Patrick s First Name: SA 0I- 518 So 51 st Avenu NTRot. O Home Address(include PO Box if applicable): slN City: County:Douglas Zip Code: Home Phone Number:402-558-0876 Business Phone Number:40 - 1- 6 58 Social Security Number: Drivers License Number&State: - - __ NE Date Of Birth: - - - - Place Of Birth:Omaha, NE Email address: Liquor.Licensing@targ£t,c©m � .. . -._ 6..w,,,, "ens n €` . ,.; ,-,.. ,, 3B, ,i � n ,, t xi x;,. IN YES ❑NO �' »-" .. .'� �r�A? " � 4, r:;;.. 9x d :rk 1 tea"'4'6 ff " k �% ^, , ,u. ' E''''''+' Spouses Last Name: QytrYch First Name:Catharene nil:A Social Security Number: - - - Drivers License Number& State: a NE Date Of Birth: - -- -— - - Place Of Birth:Omaha, NE CITY& STATE YEAR .:YEAR CITY & STATE YEAR ` YEAR FROM TO FROM TO Omaha, NE 1995 Present Omaha, NE 1995 Present J Form 103 REV JAN 2015 Page 3 of 6 YEAR TELEI'H1 E FROM TO NAME OF EMPLOYER NAME QF SUPERVISOR pi v�ER 1981 Present Target Corporation Anson Stephen 402-597-3033 1977 1981` LeCasa Pizzeria Nicole Jesse 402-556- 464 1. READ CAREFULLY. ANSWER CO PLETEL.Y AND ACCURATELY. Must be completed by both applicant and spouses 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 my charge allesina 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 the conviction or plea. Also list any charges pending at the time of this application. If more th ist charges by each individual's name. NOV 6❑ YES NO Z NEB AKA LIQUOR If yes,please explain below or attach a separate page. CONTROL COMMISSION Date of Where Description Name of Applicant Conviction Convicted of Disposition (mmJyyyy) (City&State) Charge 2. Have you or your spouse ever been approved or made application for a liquor license in Nebraska or any other state? ti IYES ENO 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? YES ❑NO Forne 103 _ ° REV JAN 2015 w . iC w LIQUOR l 4or6 t CONTROLCO C 4. List the alcohol related training and/or experience(when and where)of the person making application. *NLCC Training Certificate Issued: Name on Certificate: Date Applicant Name (m YYYy) Name of program(attach copy of course completion certificate) Patrick IDytrych Target In-House required alcohol training FIECEIVEI) NEBRAS ;A LIQUOR CONTF1OL COMMISSION `For list ofNLCC Certified Training Programs see www.lcc.ne.7ov traintinginfo.htjrrl Experience: Date of Applicant Name/Job Title Name&Location of Business: Employment: Patrick Dytrych/Store Team Leader Been in role at Target Store T-2383 since 11/2011 } 5. Have you enclosed Form 147 regarding fingerprints? ©'YES ONO Form 103 REV JANI 2015 ;Pastsof6 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 §53-13.1.01)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 FederaI), 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. (. NOV 6 20 ,,,../ , or BRASKA LIQUOR Si a c€ 'n _er Applicant R LCOMMISSION pp Signal of use ACKNOWLEDGEMENT State of Nebraska County of �i. 54_...5" The foregoing instrument was acknowledged before me this ()e-46i)er- D 2 /5 by a Ill 4- a' .ie Dy tfrycit I date name of person acknowledged _______ie .„_. # Affix Seat UK 1 Notary Public signature '+ TIMOTHY sun yr combo.JurYB.2Cis 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. RECEIVED Form tO3. REV JAN 2015 CONTROL.. COMMISSION Print Form SPOUSAL AFFIDAVIT OF Office Use -',, NON PARTICIPATION INSERT cRECEIVED NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH NeftigAsKA PO BOX 95046 L� L 'COt:1,NE 68509-5046 ' f3 E: 402)471-2571 :� �-_ ax:(4o-2)47d-2814 NEB ` l ISSION � WV site wwvv;dcc.ne gav CUTh ROL COMM . z s v3 a�a 5r k u : caFa9ay(e!}t ask � " ,} p :8� G 4 ig � C k 1.tit f .�,ra S „r ' �'s 7�� ) i !➢ . 4 &1 `k 3€z3C , ciT be #. r p,� t d 4�. cnr ' ki +}p Y °fit.de I. -8 i ¢; - �& i a -f • ''n,.,k ' k k3 i�,�,- .,, ,, x ad +b�i4 Q.,„.„,,, a„x ,,/,;`g, a A a '0'" t 1 ; i e €a t ,¢:k dist�,� 4' W x k Y a A? k i I, '*' i , i ' '�{„` 1�'9.'" i -r4; tat ,,,, ",, w ' 4'? l x`" H e, .&"' "` S" a'4 ° y 'Ti. 7'''. r t *t, `a q. 1 w x.. ,, il'+�Si €.-` ., a ! t , 5 t. L� _. Catharene Dytrych Signature of spou as ' for waiver Printed name of spouse asking for waiver (Spouse of individual listed below) State of !b .:� F,Y,r cf County of it'91(.S The foregoing instrument was acknowledged before me this c y-- gD a /5 by - i-teiene, 4--try c,, name of person acknowledged • Affix Seal s��## ��}}**��y�y,.�� y,�,.�,, RAL L)IM 4 ite a twill Notary Pu c signature O *Omni Julle,201 �wld I e �i : I �sl s x=i d � t• le . , sslon rrt ., -, ." curse s )tie v. Patrick Dytrych Signature of in dual " vo ved with application Printed name of applying individual (Spouse of inn' idual listed above) State of / htzu, r County of dr1„( Q S The foregoing instrument was acknowledged before me this [- 1 c C, c t7 by i)ct`tIZC—A" 1 4--i'y c in to name of person acknowledged ... Affix Seal jesionAL m' / icsignature In compliance with the ADA,this spousal affidavit of non participation is available in other formats for.persons with disabilities. A ten day advance period is requested in writing to produce the alternate format. FORM35-4178 Revised 1l2OO8 , - , \ N OF FINGERPRINTS/ ,,,..,,. .. - sUBMSSSio v PAYMENT OF FEES TO NSP-CID NEBRASKA LIQUOR CONTROL COMMISSION p, ,j 301 CENTENNIAL MALL SOUTH T , , 4.E„,,,As4,,,,,,v, PO BOX 95046 NE41ASKA 4 ,- f LINCOLN,NE 68509-5046 Lit) „„„„,,-,,rcrricoff. it PHONE: (402)471-2571 FAX:(402)471-2814 \V eb5 it e: W‘t IA...ICC.11e.go 1 Applicant Name: STL of Nebraska, Inc• (Corporation,LLC,Partnership or Individual) Trade Name: Target Store T-XXy„,x_ ' ------ (Doing Business As 1 ( 61i) 761 — 1015 'iv , Liquor.Licensing@targ . ''' Pb°11e Number ,-0,e 04 Contact E-mail Address FO 1 E , ... 1) R SUB , - RPRINTS AND FEE PAYMENTS. • See New Application Requirement Guide for listing of Fingerprint Requirements, found on our N\ebsi le under-Licensing"tab in -Brochures". • 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. person must be made directly to the NSP; , . 01 go,lisr„ • theFeeYpoauymmaeyntsoufbmS2i8t.75 p paymentey through the NSP PayPort online w syfsotlelnoiaig ww,‘N ne tn or checks made payable to NSP should be mailed directly to the address: The Nebraska State Patrol—CID Division 3800 NW le Street Lincoln, NE 68521 • 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 In cure proper application of pajment • This completed form MUST be included with your Liquor License Application and/or Managerdd/oAritionof Application or Changes to: Corporate Officers or Stockholders, LLCMem Members, Spouse where new fingerprint cards are required(see New Application Requirement, Partners o Guide). • Fingerprints are not required for spouses that have no involvement with business - Spousal Affidavit of Non Participation(Form im) is required in lieu of fingerprints. Please complete information on the following pages for EACH FORM 1 47 11111111111111 EV MAR2015 1500025841 PAGE 1 _ - I,Name: Patrick J Dytrych Title: Store Team Leader How was payment made to NSP? PAYPORT OCHECK SENT TO NSP REr:Fit, Fr, 2. Name: How was payment made to NSP? DNSP PAYPORT OCHECK SENT TO CONIFirL 3. Name: How was payment made to NSP? DNSP PAYPORT OCHECK SENT TO44§,er., • 4. Name: Title: How was payment made to NSP? DNSP PAYPORT OCHECKe • „Skit -rPO4 4/0/1 04, 5, Name: 4745S70 Title- HOW was PaYinellt t,. NSP? ONSP PAYPORT OCHECK SENT TO NSP 6. How was payment made to NSP? DNSP PAYPORT OCHECK SENT TO NSP 7. Name: Title: How was payment made to NSP? EINSP PAYPORT OCHECK SENT TO NSP 8. Name: Title: How was payment made to NSP? DNSP PAYPORT OCHECK SENT TO NSP 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): Rachael Vegas Title: Vice President Signature: 1):\aCh-..,ckg \,j, Date: 10 FORM 147 REV MAR 2015 PAGE 2 CityofOmaha, WJthraska �o��MAHA�N�� 1819 Farnam —Suite LC 1 z g�i �'� Omaha, Nebraska 681 83-01 1 2 �S. v. 1► '^ 96, Buster Brown (402) 444-5550 6� City Clerk FAX (402) 444-5263 o 9TFD FEBOsg December 7, 2015 STL of Nebraska, Inc. Application to appoint Patrick J. Dytrych Dba"Target Store T-2326" manager of your present Package and 16959 Evans Plaza Catering Liquor 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 22, 2015 . 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, Buster Brown City Clerk BJB:clj City ® , 9VibrasfsaoMAxe lv 9 dP 6460 7r" � rt►, 1819 Farnam —Suite LC 1 ..b,�I1� 0 itt Omaha, Nebraska 681 83-01 1 2 cYri t '^ Buster Brown (402) 444-5550 � t't ' 0 4ry City Clerk FAX (402) 444-5263 �91FD FE13.04 December 7, 2015 Patrick J. Dytrych Application to be appointed manager of the 518 South 5 1st Avenue present Package and Catering Liquor License Omaha, NE 68106 locations for STL of Nebraska, Inc. - SEE ATTACHED LIST 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 22, 2015 . 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, , 47",X---;,exe Buster Brown City Clerk BJB:clj PACKAGE WITH CATERING STL OF NEBRASKA, INC. 4001 NO 132ND ST 68164 DBA TARGET STORE T-530 STL OF NEBRASKA, INC. 17810 WEST CENTER ROAD 68130 DBA TARGET STORE T-1777 STL OF NEBRASKA, INC 6636 NORTH 73RD STREET 68122 DBA TARGET STORE T-2010 STL OF NEBRASKA, INC 7200 DODGE STREET 68114 DBA TARGET STORE T-2125 STL OF NEBRASKA, INC 16959 EVANS PLAZA 68116 DBA TARGET STORE T-2326 STL OF NEBRASKA, INC. 12500 "K" PLAZA 68137 DBA TARGET STORE T-2383 E-MAILED NLCC jZ. -/S o sra8 ati� O i M�. STATE OF NEBRASKA lft lip Nam+ LAQUOR commission vernor *B. ;ExecccttveDirector 1 Centennial Mall South,5th floor MANAGER RECOMMENDATION P-0.ttot9so46 Lincoln,liebraeria c 508‘50a6 Phone( 92)471- 71 DATE: November 20,2015 Fax(4021471-2814 or(402)471-2374 -` TRS USER 800 837352(11Y1 web address:http://wuw.cc.ne.gov/ TO: Omaha City Clerk EMAIL:carman.rohnson citvofornaha.org MANAGER: Dytrych, Patrick J LICENSEE: STL of Nebraska,Inc.,dba Target Store T-2383 LICENSE#: Class DK-73139 r; { DUE DATE: January 5, 2016 cxz r_ n rr- Attached is a copy of a new manager application submitted to Nebraska Liquor Control ommissian, Please complete the following to submit your recommendation. Send back tohannon Nyhoff "t Shannon.nvhof (anebraska.gov or fax to{402)471-2814,with questions call( 2)471-2572. APPROVED CC1D#1613 DECEMBER 22, 2015 NO LOCAL RECOMMENDATION DENIED COMMENTS: (may attach minutes and/or additional note CLERKS SIGNATURE: DATE: i/: 021 Jeolee.114,,Wlebusch Robert Batt Bruce Bailey Coironssbtuner Chairman Commissioner An Equal Opportunity Employer 2. 3Y.3 MANAGER APPLICATION Office use INSERT-FORM 3c RECEIVED NE$RASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH PO BOX 9SG46 NOV 6 2015 LINCOLN 68509-5046 � 1 PHONE:(402)471-2571 LIQUOR FAX:(402)471-2814 CONTROL COMMISSION Website:www.lec.ne.cov MUST.BE: ✓ Citizen of the United States. Include-conv of US birth certificate,naturalization paper or current US passport ✓ Nebraska resident. Include copy of voter reEistration in the State of Nebraska ✓ Fingerprinted. See Form 147 for further information,this form MUST be included with your application. ✓ 21 years of age or older Name of Corporation/LLC;STL of Nebraska, Inc. DK Liquor License Number: 73139 Class Type of new application leave blank) Premise Trade Natne/)1BA;125 Target Store T-2383 Premise Street Address: �� Plaza City:Omaha County:Douglas Zip Code:68137 Premise Phone Number:402- - 658 Email address: Liquor.Licensint,,' @tcargeLcor 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. Click on this link to see authorized individuals. httn://wtvw.kc.ne.Rovllicetise search/licsearch.cei g a ..r..: ..:`. e* _ f`>' g, +'�t t°' t."- . .«.a (Faxed signatures are acceptable) ;a Form 103 REV JAN 2015 1500025596 �., Page 2 of 6 RECEIVED ivtP 'f]s'� 5 $ 4 t��`L .'� 5 i�ma•��y�l 1F CLEARLY 2.015 NEBRA K ;' Qt1 3f Last Name: t ytt" /Ch First Name:Patrick coN OL it" ON Home Address(include PO Box if applicable): $ SoAvenue City: County:county:Douglas Zip Code: Home Phone Number:402-558-0876Business Phone Number:402-201-2658 Social Security Number: - - - - _ _ - Drivers License Number&State: Date Of Birth: Place Of Birth:Omaha, NE Email address:Liquor.LiCensing©target.Com YES ❑NO Spouses Last Name: Dytrych First Name:Catharene A mt: Social Security Number: - - - _ Drivers License Number& State: NE Date Of Birth: - - - ` - Place Of Birth:Omaha, NE 4 - �.... * ..z§t.. .:' ,._ • b.,'.a ;� ."�`'.�'"x�. ,� �� .. 41 . > f a jti'�. YEAR YEAR YEAR YEAR CITY& STATE FROM TO CITY& STATE FROM TO Omaha, NE 1995 Present Omaha, NE 1995 Present Form 103 REV JAN2015 Page 3`af6 TELEPII OriE k'I2M A TO NAME OF EMPLOYE R NAME OF SUPERVISOR isajAmER 1981 Present Target Corporation Alison Stephen 402-591-3033 1977 .1981 LaCasa Pizzaria Nicole Jesse 4024556-6464 1, READ CAREFULLY. ANSWER COMPLETELY AND ACCURATELY. Must be completed by both applicant and'sprouse, unless spouse l filed an af1!ida it of non- partcipation. Has anyone who is a party to this application,or their spouse,EVER been convicted of or plead guilty to any chafe. Charge means g y 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 osf the conviction or plea. Also list any charges pending at the time of this application. If more than one party,please list charges by each individual's name. O YES Ei NO If yes,please explain below or attach a separate page. NOV 6 1\1 R r;LASickALIQUOR Date of Where Descrip l TRt . C 1 , Name of Applicant Conviction Convicted of . ,s,.f, e'.ON } (mmlyyyy) (City&State) Charge 2. Have you or your spouse ever been approved or made application for a liquor license in Nebraska or any other state? "OYES ONO IF YES,list the name of the premise(s): C, . t 3. Do you,as a manager,qualify under Nebraska Liquor Control Act(§53-131.01)'and do you intend to k supervise,in person,the management of the business? ®YES ONO Form 193 REV JAN 2015 p $ 8 g� Page4of6 4. List the alcohol related training and/or experience(when and where)of the person making application. *NLCC Training Certificate Issued: Name on Certificate: Date Applicant Name _ Omm yy ) Name of program(attach copy of course completion certificate) Patrick Dytrych Target In-House required alcohol training RECEIVE. Ie EBP ,, ii CONTROL IS se loll *For list of NLCC Certified Training Programs see www.lcc.ne.govrtraininginto.html Experience: Applicant Name/Job Title Die of Name&Location of Business: Employment: Patrick Dytrych/Store Team Leader Been in role at Target Store T-2383 since 11/2011 5. Have you enclosed Form 147 regarding fingerprints? ®YES [INO Form 103 REV JAN 2015 Page of .11 C i NEBRASKA LIQUOR The above individual(s), being first duly sworn upon oath, deposes and staefs� �� + ' 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 §53-131.41)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. Signatu of _er Applicant Signa of use ACKNOWLEDGEMENT State of Nebraska County of ( yk5 The foregoing instrument was acknowledged before'me this .C) j byf!l date name of person acknowledged Affix Seal Notary Public signature rTAAY,SII 7161011ff 81►IM VycCorixn.egx Adye.2ate 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. Pc"NEIli Form 103 r REV JAN 2015 i. .a `:e ,S� P ,.i �Fl Page 6 of6 CONTROL,. i._ COMMISSION IA,1 POnt SPOUSAL AFFIDAVIT OF office Use ti NON PARTICIPATION INSERT �rf, NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH ` 2i fi i'' PoBOX.95046+, 3 V 6 2015 uhroDust.NE 68509-5045 R A tJ PHONE (402)471-2571 FAX:(402)471-2814 NE BRAS A f f C � ION Website: www b�,ne ov000NTROL OMMI* � f 3s t, t d 4 e t g sw '' s 4 . pk".. ., ' :f;t $$ 'Gd :$ 'm i4 '' 3 i $ ° A$ '�` $ i 3 n t4fr "n 4t '.` �� m S @1 - „& 14Ea IT 6 tt C M ,“ .` z, ,, ,, , �.. >gf S s ne .l4� ti Ste a es F6. # j 1 4 ' n,a 3E P� i ' q ". }a `a e- B Y t' sgr � s�sxq' �,�R� �. ','. ® E -' -.,_ Catharene Dytrych Signature of spou as.,,,Atkfor waiver Printed name of spouse asking for waiver (Spouse of individual listed below) State of / e-461 "fir t . County of 1 ets The foregoing instrument was acknowledged before me this r- O 15 by Cam- verl e. 1)7415, C/N gate name of person acknowledged 2046k Affix Seal �tt��y Notary Pu. signature ....d*.el"d etectreL119•JUIY%an m a � d k 1 . '1 r Patrick Dytrych Signature of in dual I vo with application Printed name of applying individual (Spouse ofind' idual listed above) IState of ,� '',; ' County of bilic9 74t S The foregoing instrument was acknowledged before me this 0C..4 er ` 1R0 /5 by Pc kt fi t i- t. r c 41 name of nowledged y ' Affix Seat ! UK IMP of limb N�� 6 � Y otary b is signature TalOTHY SUM t,Igtla m eikathtS.tell b1 compliance with the AIA,this spousal affidavit of non participation is available in other formats for persons with disabilities. Men day advance period s requested in writing to produce the alternate format. FORM 35-4178 Revise 1/2008 f SUBMISSSION OF FINGERPRINTS/ PA 10/TENT OF FEES TO NSP-CID .., NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH 1::'-)- 2 6 70,5 PO BOX 95046 LINCOLN,NE 68509-5046 F1r7.804-1„SKA LI*4:911114 '' h-- 1 - PHONE: (402)471-2571 C mu.....uiemmii._._._.__Rr- $4,1,- '''' ,, • ra: -.. ... ,, ,6 , ,, 2 FAX:(402)471-2814 IMIN License*11.1111111.1111.111111111_ \Vebsite: NN‘114.1ccale.go‘ APPlicant Name: STL of Nebraska, Inc. (Corporation,LLC, Partnership or Individual) Trade Nam Name. Target Store T- 4,, ••.i g Business As) Ptik,, I )001 Pq k.j 61i)761 . -, , Liquor.LIcensing@targetcorn Phone Number 404." sf , Contact E-mail Address, L3uBliftx TING RPRINTS AND FEE PAYMENTS: • See New Afplication Requirement Guide for listing of Fingerprint Requirements, found on our \\el'Istle under sLicensing"tab in "Brochures". • 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. • Fee payment of$28.75 per person must be made directly to the NSP; You may submit the payment through the NSP v. Pay Pa Port online system at w v,.ne.goN 20'nsn 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 • 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. • 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). • Fingerprints are not required for spouses., lieuin of fingerprints. Please complete information on the following pages for EACH ripro„,.. 4:——, • - 11111111110111 iv FMOARRM 20151 4 7 1500025841 PAGE 1 , Patrick J Dytrych Title:______________Store Team Leader i.Name: How was payment made to NSF? liiNSP PAYPORT OCHECK SENT TO NSF 2. Name:_____________________________Title: How was payment made to NSF? ONSP PAYPORT OCHECK SENT TO NSA_ 3. Name:_____________________Title: How was payment made to NSF? ONSP PAYPORT DCHECK SENT TO4W 4. Name: Ti tie How was payment made to NSF? ONSP PAYPORT OCHECKL5M4P''1.101.1g ,k ,:,-, 5. Name:__ Title: -Sir 'Iriti°0 o'll , 11' 1-1°W 1414 PaYment t"- 1:4:1 NSF? ONSP PAYPORT OCHECK SENT TO NSA Title: How was payinent Madeirt NSP? ONSP PAYPORT DCHECK SENT TO NSF 7. Name: Title: _ How was payment made to NSP? ONSP PAYPORT OCHECK SENT TO NSF 8. Name: Title: How was payment made to NSP? ONSP PAYPORT OCHECK SENT TO NSP 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): Rachael Vegas Title: Vice President, Date: le/i I /5-- Signature:1RaCk4f4 i \j,. c_ez,„ I FORM 147 REV MAR 2015 PAGE 2 - _---_,-- City ofOmaha, 9VJthrasIa MAHAAp f/1%11ay: � �' tea 1819 Farnam — Suite LC 1 i i�� Omaha, Nebraska 681 83-01 1 2 n� r.rl Cil '^ O'":% �.yt�a{'► fin?, Buster Brown (402) 444-5550 40 City Clerk FAX (402) 444-5263 po 4to FEB11 ' December 7, 2015 STL of Nebraska, Inc. Application to appoint Patrick J. Dytrych Dba"Target Store T-2383" manager of your present Package and 12500 "K" Plaza Catering Liquor License location Omaha,NE 68137 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 22, 2015 . 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, 5 Buster Brown City Clerk BJB:clj City of OmaFia 9Vibraska �°„°MA�,A,�,�B� 1819 Farnam — Suite LC 1 n Omaha, Nebraska 681 83-01 1 2 �� .rvc;alitzus Wa Buster Brown (402) 444-5550 0�', 'h? City Clerk FAX (402) 444-5263 04 4� �4FD FEI3It '4 December 7, 2015 Patrick J. Dytrych Application to be appointed manager of the 518 South 51 st Avenue present Package and Catering Liquor License Omaha, NE 68106 locations for STL of Nebraska, Inc. - SEE ATTACHED LIST 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 22, 2015 . 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, Buster Brown City Clerk BJB:clj PACKAGE WITH CATERING STL OF NEBRASKA, INC. 4001 NO 132ND ST 68164 DBA TARGET STORE T-530 STL OF NEBRASKA, INC. 17810 WEST CENTER ROAD 68130 DBA TARGET STORE T-1777 STL OF NEBRASKA, INC 6636 NORTH 73RD STREET 68122 DBA TARGET STORE T-2010 STL OF NEBRASKA, INC 7200 DODGE STREET 68114 DBA TARGET STORE T-2125 STL OF NEBRASKA, INC 16959 EVANS PLAZA 68116 DBA TARGET STORE T-2326 STL OF NEBRASKA, INC. 12500 "K" PLAZA 68137 DBA TARGET STORE T-2383 STL of Nebraska, Inc., dba `Target Store", requests permission to appoint Patrick J. Dytrych manager of the following present Package and Catering Liquor License locations re: #T-530, 4001 North 132nd Street; #T-1777, 17810 West Center Road; #T-2010, 6636 North 73rd Street; #T-2125, 7200 Dodge Street; #T- 2326, 16959 Evans Plaza and #T-2383, 12500 "K"Plaza. 12-22-15;cj RECEIVED Presented to Council: December 22, 2015 - Approved 7a Buster Brown City Clerk