RES 2015-1083 - Appoint Alex A Priest manager of Bemis Center for Contemporary Arts 1 " �� ' `' C �`� E STATE OF NEBRASKA
NEBRASKA LIQUOR CONTROL COMMISSION
.'- ,, u? ,r.;g 1 Pete Ricketts .JUL �� 9 Hobert B. Rupe
'N , GovernorExecutive Director
i - 301 Centennial Mall South,5th Floor
P.O. Box 95046
CITY CLERK Lincoln.Nebraska 68509-5046
l ;; + n " Phone(402)471-2571
K�' Fax(402)471 2814 or(402)471-2374
TRS USER 500 S33 7352(TTY)
u?eb address Otto www.lccne.gov'
July 15, 2015
OMAHA CITY CLERK
1819 FARNAM STREET LC-1
OMAHA NE 68183
RE: Manager Application Alex A. Priest
LICENSE #IK-84061
Dear Clerk:
Enclosed is a copy of a manager application for Alex A. Priest, in connection with the Bemis Center For
Contemporary Arts, located in Omaha.
Please present this application for manager to your City/Village Council or County Commissioners and
send us the results of their action.
Sincerely,
Jacqueline Rodriguez
Licensing Division
NEBRASKA LIQUOR CONTROL COMMISSION
402-471-2571
encl.
Janice M.Wiebusch Robert Batt Bruce Bailey
Commissions? Chairman C: rrn?stoner
An Equal OpnortunEf.Entploper
MANAGER APPLICATION Office Use
INSERT-FORM 3c
NEBRASKA LIQUOR CONTROL COMMISSION
301 CENTENNIAL MALL SOUTH
PO BOX 95046
LINCOLN.NE 68509-5046 ' m
PHONE:(402)471-2571
FAX:(402)471 2814 `"5w
Website NV,' .nea()~,
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 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
Corporation/LLC information
Name of Corporation/LLC: SA S CEJ`3ItI- pv1- GoN resit t rs
Premise information
Liquor License Number: 0 610 6 ( Class Type ,f [' (if newapplication leave blank)
Premise Trade Name/DBA: Ffv\t,5 C F0•1- tam r 17- i
Premise Street Address: 724 lk) t Zi
City: OYricktfik- County: 000071-4k./? Zip Code: BED
Premise Phone Number: '¢oZ- . 541` 71'D
Email address: i Cne 1-G s -eAttr'u(,�
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://w-ww.lcc.ne.govflicense search/Research-cal
SI4 URE REQUIRED BY CORPORATE OFFICER /MANAGING MEMBER
(Faxed signatures are acceptable)
rarm lO3
REVJAN2015
Page 2 of 6
1500016667
Manager's information must be completed below PLEASE PRINT CLEARLY
Last Name: r(2-letg- First Name: A-1- MI:Home Address Address(include PO Box if applicable): o 1911-6 C ik 30 4
City: 0 frOkt+A- County: I>) 1-441--E---' Zip Code: 8'1Q-2
Home Phone Number: 5-52-0 I"la,z Business Phone Number: 107---34/ 3
Social Security Number: Drivers License Number& State:
Date Of Birth: Place Of Birth: 1110'NIES 100461-
Email address: Al It)t be4ifti,S, e-trifer• o(7.5
Are you married?If yes,complete spouse's information(Even if a spousal affidavit has been submitted)
E YES KNO
Spouse's information
Spouses Last Name: First Name: MI:
Social Security Number: Drivers License Number& State:
Date Of Birth: Place Of Birth:
APPLICANT&SPOUSE'MUST IAST RESIDENCE(S)FOR THE PAST TEN 10)YEARS
APPLICANT - SPOUSE
YEAR YEAR
CITY& STATE YEAR CITY & STATE YEAR
FROM TO FROM TO
orvvottm- ZO1I zolit 4vj (own- zoo 6, .0
romm1016-47-611 14- 11/9 zoo(0
Form 103
REV JAN 201S
Page 3 of 6
1L
MANAGER'S LAST TWO EMPLOYERS
YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE
FROM TO NUMBER
Mt Zo cS o t5 (,g-)Ti - /4t ra 1-J 102,---34/- 7 r 3 d
1000 7.ot iS� 01 tl DittP46. PE6/ 15'2-g4 -3956
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-4in one p y, please list
charges by each individual's name.
I I YES \ NO
If yes. please explain below or attach a separate page.
Date of Where Description
Name of Applicant Conviction Convicted of Disposition
(mm/yyyy) (City&State) Charge
2. Have you or your spouse ever been approved or made application for a liquor license in Nebraska or
any other state?
YES 'NO
IF YES, list the name of the premise(s):
3. Do you, as a manager, qualify under Nebraska Liquor Control Act(03-131.01) and do you intend to
supervise, in person,the management of the business?
YE S fNO
Form 103
REV JAN 2015
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:
Applicant Name Date Name of program(attach copy of course completion certificate)
(mm/YYYY)
*For list of NLCC Certified Training Programs see www.lcc.ne.aov/traininginfo.html
Experience:
Applicant Name/Job Title Date of Name&Location of Business:
Employment:
5. Have you enclosed Form 147 regarding fingerprints?
YES ENO
Form 103
REV JAN 2015
Page 5 of 6
PERSONAL OATH AND CONSENT OF INVESTIGATION
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.
ig ture of nager Applican Signature 9fSpouse
ACKNOWLEDGEMENT
State of Nebraska LJ County of p�/q I The foregoing instrument was acknowledged before me this
7`4 of4.1 crc l�y' a�,s-~ by ,4/6 A i's/
(Qule name of person acknowledged
.t%"Cw /�. Affix Seal
Notary Public signature GENERALNOTARY-StateofNebraska
REID M.KATHOL
My Comm.Exp.November 15,2017
In compliance with the ADA,this application is available in other formats for persons with disabilities.
A ten day advance period is required in writing to produce the alternate format.
Form 103
REV JAN 2015
Page 6 of 6
CityofOmaFta, Wibrasfa �� 8�9s
v
0 -1r4Va?j l
1819 Farnam — Suite LC 1 �W �1�, '�r' �
Omaha, Nebraska 681 83-01 1 2 �grv-!l ' r '^
Buster Brown (402) 444-5550 �,o --'4"..---: ' ti,
City Clerk FAX (402) 444-5263 o+P,O v,1-
FD FEBR
August 4, 2015
Bemis Center For Contemporary Arts Application to appoint Alex A. Priest
724 South 12th Street manager of your present Class "I" and
Omaha,NE 68102 Catering Liquor License location
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 August 18, 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 Oma1w W OMAHA, N
1819 Farnam — Suite LC 1 z � I,
Omaha, Nebraska 681 83-01 1 2 elirh '.r ��
Buster Brown (402) 444-5550 �,o`; = ,y,
City Clerk FAX (402) 444-5263 4P9
TFD FEBR3-
August 4, 2015
Alex A. Priest Application to be appointed manager of the
801 Pacific Street#304 present Class "I" and Catering Liquor License
Omaha, NE 68108 location for Bemis Center For Contemporary
Arts", 724 South 12th 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 August 18, 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
Cif
No. Mg.
Bemis Center For Contemporary Arts, 724
South 12th Street, requests permission to
appoint Alex A. Priest manager of their present
Class "I" and Catering Liquor License location.
08-18-15;cj
RECEIVED
Presented to Council:
August 18, 2015 - Approved 7 c
Buster Brown
City Clerk