Filing Letter to Board in Response to M Bennett Email with Exhibits 12 02 2024

*, Area Number % ol business owned or controlled Check position that applies: _ _ _ Number of shares Sole owter Partner Stockholder President _ Mce-President Secretary Treasurer Trustee _ Manager Beneficiary dner lspeotyy - Executor/Ad inistrator Direclor

Page 1OA PLEASE TYPE OR PRINT ALL INFoRMATIoN srArEAssrGNED Lrceruse Nurvrasn /051- 3 et _o" I ALL APPLICANTS ANSWER THE FOLLOWNG IADD PAGES AS NECESSARY] SOLE OWNERS AND PARTNERSHIPS: Comptete this page in full. LIMITED PARTNERSHIPS: All information about a general partner or partners ofa limited partnership must be reported, whether the general partner is an individual or a corporation. A list of the names and addresses of all limited partners must be submitted as an attachment to this application with an identifcation ofthe percentage of each limited partner as it relates to total ownership ofthe business entity to be licensed. coRPoRATIONS: All corporation applicants or ljcensees and any corporation that has an ownership interest in the corporation under license or to be licensed musl have been reported on Page 10. information on this Page, 1OA, wili identily all officers, directors and stockholders holding one percent ormore oftheshares ofthe respeclive company. Club licenses must list names of officers and direclors and attach a current membership list. ************l}**t********!r*t*'r***t**it*********t**********t*******t***********+******i1,.******i*******r************* NAME OF CORPORATION OR CLUB CORPORATION OR PARTNERSHIP): BY THIS a ame of individual (r ast name first ), stockholder, partner, Lar PLETE ONLY IF APPLICANT OR E OCKHOLDER IS A (, t or director; Last Name me Street Address Number P.O. Box#_ stat- Municipality zip Social Security Number Date of Birth Home telephone number Offlce telephone number % of business owned or controlled _ _Sole owner _ partner _ President _ Vice-president _ Secretary _ Trustee ,Manager _Agent Check position that applies: _ _ ........._ Beneficiary Number of sharcs Stockholder Treasurer Direclor --ylOtner Gpecifyl Name of individual (last name first) , stockholder, partner, officer or director: Last Name Home Street Address First Name Number P.O.Box#_ Municipality Middle lnitial Street Name State Zio Number_ -_ Date of Bidh Home telephone number (_)_Area Exchange Number Office telephone number (_)_ Area Exchange Number % of business owned or controlled _ Number ofshares Check position that applies: _ Sole otvner _ Partner _ Stockholder _ President _ Vice-president Secretarv _ Treasurer _ Trustee _ Manager _Agent _

r % of business owned or controlled _ Number ofshares Check position that applies: _ Sole otvner _ Partner _ Stockholder _ President _ Vice-president Secretarv _ Treasurer _ Trustee _ Manager _Agent _ Executor/Administrator Beneflciary (specify) Other _ _ _ Social Security Director Receiver

PLEASE ryPE OR PRINT ALL INFORMATION Page 11 .TATEASSTGNEDL,"r LICENSE PERIOD "r*u*rr APPLIED FOR &) llof 7 FROM ) ) ) ) ) County of As provided by law (R.S. 33:1-35), + 0 TO State of AFFIDAVIT -d-Ogt DATE SS (Check One) 1. The lndividual Applicant 2. Members ofthe Partnership Applicant, . IJ Pa*-AJo--"[*l{i Pr;sid;;ffi " ce+'rsioent ) ration or Club Name) consentl s; ifi'aTmeflefi'sed premises a nd a I porlio ns ofthe building constituting the licensed premises, in ing allrooms, cellars, dosets, out-buildings, passageways, vaults, yards, aftics and every part ofthe structure ofwhich the licensed premises are a parl and all buildings used in connection therewith which are in his/her/their possession or under his/her/their control, may be inspected and searched without warrant at all hours by the Direclor of the Division of Alcoholic Beverage Control, his or her duly authorized deputies, inspectors or investigators and allothersworn lawenforcement offlcers, and being duly swom according to law, upon hivher/their oath(s), depose(s) and say(s)that he/she is (they are)the person(s)duly authorized to sign the application, that in instance ofcorporate ownership, the signator is authorized by corporate resolution to sign on behalf of lhe corporations; and that the contents of this application represent complete disclosure ofthe fact, and that the contents of this application are true. -C I (Signalure of lndividual Agent / Sole Proprietor) (Corporations Only) Attestation by Corporate Seselary (Partnelship Name) (Signature of Partner) e Attest: c Secretary b A orate N ame (Signature of Partner) of rate President or Vice President) (Signature of Partner) Sign U sis Affix Corporate Seal (Signature of Partner) Sworn to and subsffibed before me 7I this AFFIDAVIT MUST BE SIGNED HERE ----> of BY DULY AUTHORIZED NOTARY PUBLIC (Printed OR AN ATTORNEY-AT.I.AW OF NEW JERSEY Notary s ssr 30 eof mtn h) Administering Oath) Officer AdminisGring Oath) 6rs6 c. zol? day of Expiration of Commission, if applicable)