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"Application for Occupation License"
-City of Blair
- --ter .z 218 S. 16~' Street
mob; ~~ ,~,~,~ Blair, NE 68008
`4+~I~ ~ ~~¢~ (402) 426 4191
The filing of this application or the granting of an occupation license neither confirms nor denies the use of the land as regulated under the provisions of the zoning
code, and is further subject to pertinent ordinances of the City of Blair which regulates and licenses specific affections and businesses.
Date: 11 ~ 2~; I ~
Business Information:
Legal Name of Business ~ i A i r2 ~_/~ ~~J~1
Common Name of Business
Business Address ~~ y~ ~A~NiN~Tc~ 5~~ City /,~t.~irz State tii~ Zip ~~u~~
Phone ~ ~~~ L t~ Fax Legal Description , ~~" ~ ~ ~ ~ fyc..~L C{ ~ ~~
Mailing Address (if different from above)
City State Zip.
Describe the nature of your business ~.~1 w:~ S i~u ~~
Do you have a monitored Security and/or Fire Alarm System at the business address? Yes ~' No
Will you be selling tobacco products at this business address? Yes No ~ .
Do you have music, vending, pinball machines or billiard/pool tables at this business? Yes No ~_
Do you sell, or serve liquor at this address? Yes No ~C`
3~~- ~~r~~ f ~~5~~
Primary Contact Name: ~y~~uL 1-lA,~'lEfL Phone S"`3~° `~Ly~ G
~~ ~ ~~
Secondary Contact Name: ~ ~~~' wRGii i~ ~ Phone ~. Yz~ -- .s'"3 3 `~
t3r.~~- C~7 /2~~~t~~f7 -
I declare under penalty of false statement that to the best of my knowledge and belief the statements made
herein are correct and true.
Signature of Owner or Corporation Agent/Owner ~f~--'/,- =',.~~---~---~_ Title ~ ~ - ~~-~-~~ ~-
OCCUPATION LICENSE REMITTANCE FEE
I hereby remit $ This is based on Section 10-902 of the Blair Municipal Code
Date Paid: 9 ~ L~ ~ ~ ~ Amount Paid: ~r f ~/ ~ Ce ss~gned: ~' ~;~
L~
OD/
December 31st, 2007
Western Surety Company
LICENSE AND PERMIT BOND
KNOW ALL PERSONS BY THESE PRESENTS: Bond No. 15os4261
That we, Paul Hamer & Gary Wachter DBA Blair Pawn
of the City of Blair ,State of Nebraska , as Principal,
and WESTERN SURETY COMPANY, a corporation duly licensed to do surety business in the State of
Nebraska
as Surety, are held and firmly bound unto the
City of Blair ,State of Nebraska , as Obligee, in the penal
sum of Five Thousand and o0/100 DOLLARS ($5, 000.00 ),
lawful money of the United States, to be paid to the Obligee, for which payment well and truly to be made,
we bind ourselves and our legal representatives, firmly by these presents.
THE CONDITION OF THE ABOVE OBLIGATION IS SUCH, That whereas, the Principal has been
licensed Pawn
by the Obligee.
NOW THEREFORE, if the Principal shall faithfully perform the duties and in ,all things comply
with the laws and ordinances, including all amendments thereto, pertaining to the license or permit
applied for, then this obligation to be void, otherwise to remain in full force and effect until
December 31st , 2008 ,unless renewed by Continuation Certificate.
This bond may be terminated at any time by the Surety upon sending notice in writing, by First Class
U.S. Mail, to the Obligee and to the Principal at the address last known to the Surety, and at the expiration
of thin (~~ five (35) days from the mailing of said notice, this bond shall ipso facto terminate and the Surety
shill thrmupon b~ , alieved from any liability for any acts or omissions of the Principal subsequent to said
date. I~~~gardles5 ~f :I,e number of years this bond shall continue in force, the number of claims made
a~ainst_'this bond. c~~~~i the number of premiums which shall be payable or paid, the Surety's totallimit of
liability shall not b~ ~ ~~nulative from year to year or period to period, and in no event shall the Surety's total
liability for all clau~5mexceed the amount set forth above. Any revision of the bond amount shall not be
Cuil]iil<~rivc.
Dated this 2nd day of Jan
Countersigned (where required)
By A ointed Agent of Surety
Form 532-2-2006
2008
Blair Pawn Shop
,,~ °•°"`""~`~ , ~ Principal
-=, _;
Principal
WESTE N SURET COMPANY
sy
Paul T. Bruflat, S for Vice President
Western Surety Company
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS:
That WESTERN SURETY COMPANY, a corporation organized and existing under the laws of the State of South Dakota, and
authorized and licensed to do business in the States of Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut,
Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine,
Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey,
New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina,
South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming, and the United
States of America, does hereby make, constitute and appoint
Paul T. Bruflat of Sioux Falls
State of South Dakota ,its regularly elected Senior Vice President ,
as Attorney-in-Fact, with full power and authority hereby conferred upon him to sign, execute, acknowledge and deliver for and on
its behalf as Surety and as its act and deed, the following bond:
One L & P Bond, Signed - Pawn
bond with bond number 15084261
for Paul Hamer & Gary Wachter DBA Blair Pawn
as Principal in the penalty amount not to exceed: $ 5 , 0 0 0. 0 0
Western Surety Company further certifies that the following is a true and exact copy of Section 7 of the by-laws of Western Surety Company
duly adopted and now in force, to-wit:
Section 7. All bonds, policies, undertakings, Powers of Attorney, or other obligations of the corporation shall be executed in the corporate
name of the Company by the President, Secretary, any Assistant Secretary, Treasurer, or any Vice President, or by such other officers as the
Board of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer may appoint
Attorneys-in-Fact or agents who shall have authority to issue bonds, policies, or undertakings in the name of the Company. The corporate seal is
not necessary for the validity of any bonds, policies, undertakings, Powers of Attorney or other obligations of the corporation. The signature of any
such officer and the corporate seal may be printed by facsimile.
In Witness Whereof, the said WESTERN SURETY COMPANY has caused these presents to be executed by its
Senior Vice President with the corporate seal affixed this 2nd day of January
2008
ATTEST ~-~ WEST /BURST COMPANY
L. Nelson, Assistant Secretary Paul T. Bruflat enior Vice President
STATE OF SOUTH DAKOTA
COUNTY OF MINNEHAHA ss
On this 2nd day of January 2008 ,before me, a Notary Public, personally appeared
Paul T. Bruflat and L. Nelson
who, being by me duly sworn, acknowledged that they signed the above Power of Attorney as Senior Vice President
and Assistant Secretary, respectively, of the said WESTERN SURETY COMPANY, and acknowledged said instrument to be the
voluntary act and deed of said Corporation.
~y4yy4bhyy0h~iyhyyyhy~-.5565 ~
s D. KRELL s
s g AE ~ NOTARY PUBLIC SEAL s n
s SOUTH DAKOTA~ss, ~/
X66666666666666666666666 ~' ~ Notary Public
My Commission Expires November 30, 2012
•~
Form F1975-9-2006 ~~~''
ACKNOWLEDGMENT OF SURETY
STATE OF SOUTH DAKOTA ss (Corporate Officer)
COUNTY OF MINNEHAHA
On this 2nd day of January 2008 ,before me, the undersigned officer,
personally appeared Paul T. Bruflat ,who acknowledged himself to be the aforesaid
officer of WESTERN SURETY COMPANY, a corporation, and that he as such officer, being authorized so to do, executed
the foregoing instrument for the purposes therein contained, by signing the name of the corporation by himself as such
officer.
IN+~~'~'~F~,y~~Sy~HyF~~IyO 4;4 ~iave hereunto set my hand and official seal.
r S. PETRIK s
~ 5 AE L NOTARY PUBLIG SEAL s
J~SOUTH DAKOTA~s
s ary Public -South Dakota
+5hyhhyhyh5yyy5s555y555hf
My Commission Expires August 11, 2010
STATE OF _
COUNTY OF
On this day of
known to me to be the individual _
that he _ executed the same.
My commission expires
ACKNOWLEDGMENT OF PRINCIPAL
(Individual or Partners)
ss
before me personally appeared
described in and who executed the foregoing instrument and acknowledged to me
Notary Public
ACKNOWLEDGMENT OF PRINCIPAL
STATE OF (Corporate Officer)
COUNTY OF ss
On this day of
,before me personally appeared
who acknowledged himself/herself to be the
of , a corporation, and that he/she as
such officer being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing
the name of the corporation by himself/herself as such officer.
My commission expires
Notary Public
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