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RES 2015-0977 - Appoint Renee L Snider manager of Walgreens 4443 EN ED STATE OF NEBRASKA Pete Ricketts NEBRASKA LIQUOR CONTROL COMIVIISSION '141:4" ir•A e; Governor 2015 JUL -9 1)ti 12: 34 Hobert Rupe ,t Executive Director 301 Centennial Mall South,5th Floor CIT CLERK P.O.Box 95046 Lincoln.Nebraska 68509-5046 NEBRASKt, Phone(402)471-2571 Fax(402)471-2814 or(402)471-2374 TRS USER 800 833-7352(TTY) web address:http://www lcc.ne.gov/ July 9, 2015 OMAHA CITY CLERK 1819 FARNAM STREET LC-1 OMAHA NE 68183 RE: Manager Application Renee L. Snider LICENSE D-86179, D-86180, #D-86181, #D-88621 Dear Clerk: Endl. ed is a copy of a manager application for Renee L. Snider, in connection with the Walgreen's 04443, 3137, 03186, and 11205, all 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 Commissioner Chairman Commissioner An Equal Opportunity Employer MANAGER APPLICATION o• .' se INSERT-FORM 3c NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH L 2 201F, PO BOX 95046 LINCOLN,NE 68509-5046 NEBRASKALIQUOR PHONE:(402)471-257I FAX:(402)471-2814 CONTROL COMMISSION Website:www.lcc.ne.gov MUST BE: ✓ Citizen of the United States. include corm of US birth certificate.naturalization naner or current US Dassnort ✓ Nebraska resident jpclude 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. I 21 years of age or older Name of Corporation/LLC: Walgreen Co. 86179 Liquor License Number: Class Type (if new application leave blank) Premise Trade Name/DBA: Walgreens#04443 Premise Street Address: 9001 West Center Rd. City: Omaha County: Douglas Zip Code: 68124 Premise Phone Number: (42) 393-8451 Email address: eric.lyles©walgreens.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. httn://www.icc.ne.eav/license search/licsearch.cei vz,,a ' SIGNATURE RE a a IRE i BY CORPORATE OFFICER/MANAGING MEMBER (Faxed signatures are acceptable) Form 143 REV JAN 2015 1500016456 Page 2 ore t coo t 1 oto 141111, t „)..A t I t3 I 1, .! It ,tt ttf nt ti# , Snider Renee Last Name: First Name: MI: Home Address(include PO Box if applicable): I ZO k) eyaivi h/il City: f)Pil 4-till County: laicivder- Zip Code: 62 13 7 Home Phone Number: eia) 6/7- gSS9 Business Phone Number: 66) 8.55 932Z IL-- Social Security Number: . , , Drivers License Number&State:, „ , Date Of Birth: Place Of Birth: tlj-si OL-4,A71 renee.snider@walgreens.com Email address: , • ,,,, 4,, . ;_ • 4-, • • E YES El NO Spouses Last Name: 6/7:cle( First Name: 46(6;0(10 A MI: Social Security Number: - fi f Drivers License Number&State: at" Date Of Birth: Place Of Birth:P5 &Se. I I YEAR YEAR YEAR YEAR CITY& STATE CITY&STATE FFtOM TO FROM TO i)enitvv, zoz 4.5611. ,11\1-6A )06 zaz AJi )19? zoz- 1:AzDIA zoni ci,i',TIaL /IX 22i$ za7 c IV RECEIVED Form 103 REV JAN 2015 JUL 2 JUN 2D1D r Page 3 of 6 2015 NEBRASKA LIQUOR NEBRASKA LIQUOR CONTROL_ COMMISSION CONTROL COMMISSION ELEPHONE '9'T� NAME OF EMPLOYER NAME OF SUPERVISORFROIVI TER J9' nrnS /1 cha e/ ` Xl fry Ooz 3-286(I) 1. READ CAREFULLY. ANSWER COMPLETELY AND ACCURATELY. Must be completed by both applicant and spouse, unless spouse has filed an affidavit of non- participation. Has anyone who is a party to this application,or their spouse,EVER been convicted of or plead guilty to any charge. Charge means 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. a 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 c'n ee 5n,de O31 zoo3 Lee) /U en(t fin. t 0311798 ,JAcelAr , L Oaf 10 oticn•cis 03//'1t' /.n(4 ive. Dci /s' C '/m9 J..wind 764,13 ,4;i ena /Z f t t y. L ,001, . /�7 -cr..>�w f trZ,to • 2. Have you or your spouse ever been approved or made application for a liquor license in Nebraska or any other state? OYES ®NO IF YES,list the name of the premise(s): 3. Do you,as a manager,qualify under Nebraska Liquor Control Act(053-131.01)and do you intend to supervise, in person,the management of the business? YES !ONO CENE* RECEIVED Form 103 f_ 2 JUN L 2n15 REV JAN2015 Page 4 of 6 NEBRASKA LIQUOR NEBRASKA LIQUOR CONTROL COMMiSSION CONTROL COMMISSION 4. List the alcohol related training and/or experience(when and where)of the person making application. *NI,CC Training Certificate Issued:48-66676,53 Name on Certificate: 7 tIn et. Si CLI 7 Date Applicant Name Name of program(attach copy of course completion certificate) (Ininirr/Y) nee c5rt:(11( 03 2a3 45:0414s,Ale ted.ofqt. .,. (tv,r-A,,'Ij Aee (.57mcji 'r 2013 iL0A Slit/ I° dIe/ id,, 1-, - _ J *For list of NLCC Certified Training Programs see www.lcc.ne,govitrairtinginfo.html Experience: Applicant Name/Job Title Date ofName&Location of Business: Employment: RECEIVED JUN 5 2015 NEBRASKA LIQUOR CONTROL COMMISSION — 5. Have you enclosed Form 147 regarding fingirprints? RGENV ) OYES ONO JUL 2 1 NEBRASKA LIQUOR CONTROL COMMISSION Form 103 REV JAN 2015 Page 5 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 information submitted in this application, is subject to cancellation if the information contained herein is incomplete, inaccurate, or fraudulent. / ignature of Manager licant Signature of Spouse ACKNOWLEDGEMENT State of Nebraska County of N C ft/ The lforegoing instrument was acknowledged before me this /L(e 9 fib'' by !. -ax. * 41.4 f '• $,ut''A - -�{/ 1 name of person acknowledged Affix Seal N Public signature 4ML My Comm.Exp.June S,2019 a. 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 JUL U REV IAN 2015 Page 6 of 6 NEBRASKA LIQUOR CONTROL COMMISSION SPOUSAL AFFIDAVIT OF otnce NON PARTICIPATION INSERT III EIV D NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH PO BOX 95046 LINCOLN,NE68500-5046 JUL 2 2015 PHONE:(402)471-2571 FAX (402)471-2814 Website: www.lcc.ne,gov NPRRASKA I 101.10R " Alle all 14.041-4wittiOrtlit.i.:4:.;'.i1.1 714,.s.:i4i;40:1Piti?21f fl,,Y.i.f;.-,: r.:, kvr,',P,/,1•-'s f'1',1,4,'!,1', s,. :.i.\....,.',;,tsq; ., :,.::..., ,,,,'„,,',,'; ', ...,,. . fipteies:'":4 - *ys'i',::,', i hfili.1,7:1:C rC:IP,..C'iV7-1 ,:`43:'; .'':0.',1'•er:1'1,." ." -- ''' ' '' ';,...^.';`'; :1-" ';15:'''''1-' "' ' 2' ''''',''';''''''`Iti t1dbat,.ice1'.....• ,t ' ",.. a.; z-,,A'17.,„...,7,„, .."-s."..".• •. ,,,t... (.. -.. ' , , , .' ' . ' " ''. ; '. ' • --, .... NYilY,„..toWixiteiii..#4."?44-..01i.,1-1,,41:::40'ill;417A';,Q1,),,_ -=•-•,..;J:, • '.."". .t....,'',_.'",;' . , - , ., .,,,,,..', -,,, .. '. ,'. •, „- ..,,'''y ':,.'....'..Q:',o'r, ,i"D-4L. /" !,...,',P;-;.;.-, _,,.-.. 7, ,...-. t 1 • * ,, , .'•.. ' -,1 “ , ,..„.,„",--ikaati A.. ; , • i.---/-,..',--ft=1,,..rt,...r,.A.104,-f,?,4;,..,r,';'4,::, ,i`''.--'4 . -'. ;...,, ''•,, . • .,,, .','-' . .-".`,.;44 ' --, , • - '• ,;.,--., Brandon Snider Signature of spouse asking for waiver Printed name of spouse asking for waiver (Spouse of indivi al isted b7w) ,... State of 97A ) _ County of (-44 C The foregoing ment was acknowledged before me this 14 otary Public s' atiure by, / name of person acknowledged 6ENIERAL NOTARY-Stats of illbraka-4 CASEY M.AYINARD MY COMM.Exp.AMOS,2019 11,#—.11**„..4- '4,''.',,,,Vg`'f.,,t ',..."ti,-',..1.61'4, ',.1,. .; ei.., ,.... .• . , . . ,; 1 . ', ,i,,'4,-1, .., , * ,•",,---, t. , .0.it.t; 'I..j. :, ,41:614Asio:411 ,.,"dily,VilSkl.p.,,-;,:i;,Triii i'4...,.-4.y.dp(6::,'6,-§,,,.....,y 7,,,i-,,,,..,,,,, ..,;.,,-':' ,, ,. ,.. ;,, ,t,4i• 1-'• '' .; '4; • .1• 4 ,:,4, ' ', ',, 4,i',•''',4 dAill$,Ilit ti:': '!.. ;:•';0 94'11" 74113;- ''`k.';' ' f.''41-6"'...kt'''..;'•7''''''' ` '.4 • • , '' 4 r IRenee Snider Signature ••f individual invo ved with application Printed name of applying individual (Spous, 6f individual listed bove) State of dtitd/1-4“ ',At r A"- County of , ,41,,,_) ' The foregoin 'nstmment was acknowledged before me this — by TIME of person acknowledged Offinir „: ,FIERA!tffitARY-State of lialwaska otary Public ..'• ,1 re 0, CASEY M.AYLWARD f - -.....• My Comm,Exp.Juana.2018 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 1/2003 ix-, Or N 1- REJ:E51V2E0i5D ,:1)tiL 2 C...ONNETBRROALSKCAOML IMQ IU S\7:O SR ION i : ,--,.. ... ...ie.",--;•-,, t\ 1,.-:.\)_., A.'," ---) e—" •. - re-747=1°7r' , ',. - \ . t....<, s....., G., I ,,„.. at 1 to. q 03 11.4. i t4 (113) . . iN ...0 —r 05 CU . .„„ gm. 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C 0 0 0) }— C co E M $..) et 1— iiir cw <0 co cs4 (11 RECEIVED cl th 0,1 CNI A Lid 0 0 JUN 5 2015 NEBRASKA LIQUOR CONTROL COMMISSION c`I cv) 1* EC IV a a JUL 2 2W5 NEBRASKA LIQUOR CONTROL COMMISSION cv) NI- Ai, 9 Z rU 4.0 °"" Z C11) L(151 — U) Lo0) X 0 z CD a) 43 c :0 1:2 ,3)U) W co -E 6- 0 ) e i-T9).• — (1) > c Vc CO E3 0 a 0 ct c CC 4.0 4111cr <, RECEIVED ;7 REC)EIVE JUN 5 2015 2 NEBRASKA LIQUOR NEBRASKA LIQUOR CONTROL COMMISSION . ,( ; Q.,.. ;), (c;) .—) t.,...,.„ Fl (.....)! 0 ..... . \—) v) m .m— ,—, 0. —) t (21 •,—,;) (t '*-10 8) -0 (C;') -si , Clie 5 •1,„,„„,i, ..._ /1144 tl. 0) E 15 k...;) i.,.,..,) i N Si c161` 6 :1;20 6"- Z cr) DE l'.....11 \ a) * ()) c E iii 0 h404 o 0 0( ..-0 ci. a c, \ x -t 0 .1.7,1t S'.. ,, (7) a) C3 ta. -- ,_.,.. 0 ,....., Naaa t 0 ; r 4.......• 02) .....\ t/ ) t , • 7 i'...2•1# w •N` ....:;\ L.' I kei c o N,,.7-.•-"r"7,r e;-',C.e•w'Cr''",-,,r-Cr're-C>,re-"r""e..-Ce"''''' A, r- A7'. t r"re rf--/'''y 7'', "r-'4. i r-, 4 -.4. o , I- Q) E 1:0 rT, CY it 41rlicr f9)....) : EVE JUL 2 2015 ) (0 a, Osi NEBRASKA LIQUOR Ct. 8, d) CONTROL COMMISSION x c4 c) RECEIVED JUN 5 2015 () NEBRASKA LIQUOR Z 6. d) c‘e CONTROL COMMISSIO 14-J ,!)) c; 2 0.= .) 4:4 re. 0 ow* 0 C, Q .1mik ' Z cr —j mow W < Co Orgio WM CC Z W 4) 0 CC ‘1::f V co .... Le) 8-"j E7- la (0 C ti 2 • a> -o .ot (4) — c oo --c" (t) 0 4.,) 0) W c a) E 2 c LP8ce to —1 City of OmaFui Nebraska 1819 Farnam — Suite LC 1 z A1` Omaha, Nebraska 681 83-01 1 2 n v.:�' ';-- ,° , Buster Brown (402) 444-5550 o.o City Clerk FAX (402) 444-5263 p49 i- TFD FE1 - July 28, 2015 Walgreen Co. Application to appoint Renee L. Snider Dba"Walgreens 4443 manager of your present Package Liquor 9001 West Center Road License location Omaha,NE 68124 Dear Liquor License Applicant: This letter is notification that a hearing before the Omaha City Council on your application to appoint a manager to the liquor license has been set for August 11, 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 Cttgof Omaha, NebraskaA, \�MAHA/ ��49 0,44 -pAt%e;:,;\ vtb- 1819 Farnam — Suite LC 1 z ' ` I ^t`� Omaha, Nebraska 681 83-01 1 2 v. "! Buster Brown (402) 444-5550 ��,o= ' `ti City Clerk FAX (402) 444-5263 9TFD FEB03` July 14, 2015 Renee L. Snider Applications to be appointed manager of the 11920 W Beam Hill Road present 20 Package Liquor License locations Denton,NE 68339 for Walgreen Co. (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 August 11, 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, II A Buster Brown City Clerk BJB;clj WALGREEN CO 3701 NORTH 132ND STREET 68164 DBA WALGREENS #03186 WALGREEN CO 9001 BLONDO STREET 68134 DBA WALGREENS #03621 WALGREEN CO 9001 WEST CENTER ROAD 68124 DBA WALGREENS #04443 WALGREEN CO 5038 CENTER STREET 68106 DBA WALGREENS #04974 WALGREEN CO 10725 FORT STREET 68134 DBA WALGREENS #05059 WALGREEN CO 7151 CASS STREET 68132 DBA WALGREENS #05143 WALGREEN CO 2323 "L" STREET 68107 DBA WALGREENS #05190 WALGREEN CO 5062 SOUTH 155TH STREET 68137 DBA WALGREENS #05360 WALGREEN CO 3001 DODGE STREET 68131 DBA WALGREENS #05741 WALGREEN CO 2605 SOUTH 171ST STREET 68130 DBA WALGREENS #05966 WALGREEN CO 15525 SPAULDING PLAZA 68116 DBA WALGREENS #06802 WALGREEN CO 4310 AMES AVENUE 68111 DBA WALGREENS #06936 WALGREEN CO 3121 SOUTH 24TH STREET 68108 DBA WALGREENS #06962 WALGREEN CO 13155 WEST CENTER ROAD 68144 DBA WALGREENS #07272 WALGREEN CO 8989 WEST DODGE ROAD 68114 DBA WALGREENS #07563 WALGREEN CO 225 N SADDLE CREEK ROAD 68131 DBA WALGREENS #07693 WALGREEN CO 5225 NORTH 90TH STREET 68134 DBA WALGREENS #10437 WALGREEN CO 6005 NORTH 72ND STREET 68134 DBA WALGREENS #11205 WALGREEN CO 13510 Q STREET 68137 DBA WALGREENS #13137 WALGREEN CO 2929 NORTH 60TH STREET 68106 DBA WALGREENS #15327 No. Walgreen Co., dba "Walgreens 4443", 9001 West Center Road, requests permission to appoint Renee L. Snider manager of their present Package Liquor License location 08-11-15;cj RECEIVED Presented to Council: August 11, 2015 - Q i -A MIN WATT A 'MAWS MI r Buster Brown City Clerk