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

Page 4 PLEASE ryPE OR PRINT ALL INFORMATION STATE ASSIGNED LICENSE NUMBER 2o2o.3i 4.1 027 oO2 IS THE NEAREST ENTRANCE OF THE PLACE TO BE LICENSED WITHIN 2OO FEET OF THE NEAREST Yes jL ENTRANCE OF ANY CHURCH OR SCHOOL? No IFTHE ANSWER iS'YES,' IS A WAIVER SIGNEO BYTHE APPROPRIATE OFFICIAL ATTACHED TO THIS Yes No APPLICATION? - _ _ DOES THE APPLICANT INTEND TO USE ANY VEHICLES FOR THE TRANSPORT OR DELIVERY OF YES NO (A TRANSIT INSIGNIA IS NECESSARY BEFORE ALCOHOLIC BEVERAGES? ALCoHOLIC BEVERAGES lvlAY BE TRANSPORTED.) -IL 4.3 - HAS THE APPLICANT FILED AN ANNUAL SPECIAL TAX REGISTRATION AND RETURN FORM (TTB F 5630,5) WITH THE FEDERAL ALCOHOL AND TOBACCO TAX AND TRADE BUREAU? _=No Only required if a change in the existing regisLration. I _l tF "YES," DATE FILED _ * _yes 4.4 wlLL ANY BUSINESS OTHER THAN THE SALE OF ALCOHOLIC BEVERAGES BE CONDUCTED ON THE Yes No PREMISES TO BE LICENSED? --I:!- IF THE ANSWER IS'YES,' INDICATE THE NATURE OF THE BUSINESS AND WHOwlLL CONDUCT IT BY RESPONDING TO THE FOLLOWING OUESTIONS: - -xrr- Applicant --rx- Restaurant Other catering Hotel/Motel other Other -APplicant _Amusements -Applicant _ N J. Lottery -Othea -Applicant Other _ Grocery or Delicatessen -Applicant -other Other (specify) country club xx npp1166n1 -Applicant -IIONTHE LICENSED 4.5 IF SOMEONE OTHERTHAN THE APPLICANT WILL OPERATE THE OTHER BUSINESS -Other PREMISES, ANSWER THIS QUESTION. IF THERE IS MORE THAN ONE INDIVIDUAL OR COMPANY, ATTACH A SEPARATE PAGE LISTING THE REOUESTED INFORMATION FOR EACH OPERATOR, Business to be operated Name of company/rndrvrdual StreetAddress Number State Municipality zip Street Name - NJ Sales Tax Certificate of Authority No

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Page 3 PLEASE ryPE OR PRINT ALL INFORMATION 2020 33 021 002 The foltowing questions identify information about the licensed premises This describes the area or place which is to be licensed forthe sale, service, consumption, delivery, receipt or storage of alcoholic beverages. If the license is ina ctive and NOT SITED AT A PLACE OF BUSINESS, answer question 3.1 only, entering N/A for "not applicable." fyou use N/A as a response to question 3.1, question 2.2 on Page 2 should also be answered N/A.l 3 3.1 HOW IVANY SEPARATE BUILDINGS ARE TO BE INCLUDED UNDER THIS LICENSE? lf more than one building is to be included under lhis license, a separate Page 3 is to be submitted covering each building An up-to-date sketch of the entire licensed premises should be submitted for inclusion in the State ABC license Ille. oF 3 ro BE LTcENSED x Yes tsrHE ENTTRE BUILDINGTo BE LIoENSED? 3,2 BUILDING NO. f, No lf the answer to queslion 3.3 is "No," specify which floors are to be under license and which ones are not by answering the following questions: 3.4 Basement 1"tfloor 2nd floor 3'd floor Yes No No - -Yes No Yes -No -Yes be included under this license: Specify each additional floor number to - All of il No All of it Yes No -Yes All of it No All of it Yes -No -Yes - Ifonly part of any floor is to be licensed, attach a more detailed explanation with sketches to clearly delineale licensed areas from unlicensed areas. 3.5 ARE ANY GROUNDS ADJACENT TO THE BUILDING UNDER LICENSE TO BE INCLUDED AS PART OF THE LICENSEO PREI\iIISES? Yes No IS THERE ANY UNLICENSED AREA LOCATED BETWEEN BUILDINGS UNDERTHIS LICENSE OR BETWEEN LICENSED 3.6 -x ADJACENT GROUNDS? Yes- X No IFTHEANSWER IS "YES," ATTACH A SKETCH OFTHE LICENSEDAND UNLICENSED AREAS SHOWING DIMENSIONS IN FEET. 3.7 DOES THE APPLICANT OWN THE BUILDING? BUILDING? DoES THE APPLICANT LEASE THE BUILDING? IF "YES," IS THERE A MORTGAGE ON THE YES -L NO YES -I!_- NO -X NO lf there is a mortgage on the property, answer question 3.8. lf the licensed premise is leased, answer question 3.9. -YES 3.8 MORTGAGEE (HOLDER OF MORTGAGE): (Last Name, First Name, Middle lnitial or Corporate Name) Street Address Number Street Name State Municipality P.O. Box # zio 3.9 LANDLORD (HOLDER OF LEASE): - Street Address -- P.O. Box # (Last Name, First Name, Middle lnitial or Corporate Name) -

reet Address Number Street Name State Municipality P.O. Box # zio 3.9 LANDLORD (HOLDER OF LEASE): - Street Address -- P.O. Box # (Last Name, First Name, Middle lnitial or Corporate Name) - Number Street Name Municipality- 7io -- State

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Page 3 PLEASE TYPE OR PRINT ALL INFORIVIATION STATE ASSIGNED LICENSE NUI\,1BER 027 002 2020 33 The following questions identify inlormation about the licensed premises. This describes the area or place which is to be licensed for the sale, service, consumption, delivery, receipt or storage of alcoholic beverages. l{ the license is inactive and NOT SITED AT A PLACE OF BUSINESS, answer question 3.'l only, entering N/A for "nol applicable." lfyou use N/A as a response to question 3.1, question 2.2 on Page 2 should also be answered N/A.l 3 3.1 HOW MANY SEPARATE BUILDINGS ARE TO BE INCLUDED UNDER THIS LICENSE? lf more than one building is to be included under this license, a separate Page 3 is to be submitted covering each building An up-lo-date sketch of the entire licensed premises should be submitted for inclusion in the State ABC license file. OF 3,2 BUILDING NO. 3 3 TO BE LICENSED. IS THE ENTIRE BUILDING TO BE LICENSED? X No Yes lf the answer to question 3.3 is "No,' speciry which floors are to be under license and which ones are not by answering the following questions: 3.4 Basemenl 1"lfloor 2nd floor 3'd floor - -YesYes -No No -Yes -No Specify each additional floor number to be included under this license: -No -Yes All of it All of it -Yes Yes -No No -No Allof it -Yes -No -Yes All of it lf only part of any floor is to be licensed, attach a more detailed explanation with sketches to clearly delineale licensed areas from unlicensed areas. 3.5 ARE ANY GROUNDS ADJACENTTO THE BUILDING UNDER LICENSE TO BE INCLUDEDAS PARTOF THE LICENSED PREMISES? x Yes No 3,6 ISTHERE ANY UNLICENSED AREA LOCATED BETWEEN BUILDINGS UNDERTHIS LICENSE OR BETWEEN LICENSED ADJACENT GROUNDS? Yes ' No IFTHEANSWER IS 'YES," ATTACH A SKETCH OF THE LICENSEDAND UNLICENSEDAREAS SHOWING DIMENSIONS IN FEET. 3.7 DOES THE APPLICANT OWN THE BUILDING? X YES lF 'YES,' lS THERE A MORTGAGE ON THE BUILDING? DOES THE APPLICANT LEASE THE BUILDING? Yes -YES No -J!--NO X NO lflhere is a mortgage on the property, answer question 3.8. lf the licensed premise is leased, answer question 3.9. 3.8 MORTGAGEE (HOLDER OF MORTGAGE) (Last Name, First Name, Middle lnitial or Corporate Name) Street Address Number Street Name slate Municipality P.O. Box # zip 3.9 LANDLORD (HOLDER OF LEASE): - Street Address -- (Last Name, First Name, Middle lnitial or Corporate

r Corporate Name) Street Address Number Street Name slate Municipality P.O. Box # zip 3.9 LANDLORD (HOLDER OF LEASE): - Street Address -- (Last Name, First Name, Middle lnitial or Corporate Name) - Street Name N umber Municipality- P.O. Box # zip -- - - State -