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

Page 10A PLEASE TYPE OR PRINT ALL INFORMATION STATE ASSIGNED LICENSE NUMBER _1802 ___-_ 33 - 005 - 011 ALL APPLICANTS ANSWER THE FOLLOWING (ADD PAGES AS NECESSARY) SOLE OWNERS AND PARTNERSHIPS: Complete the page in full. LIMITED PARTNERSHIP: All information about a general partner or partners of a 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 identification of the percentage of each limited partner as it relates to total ownership of the business entity to be licensed CORPORATIONS: All corporation applicants or licensees and any corporation that has an ownership interest in the corporation under license or to be licensed must have been reported on page 10. Information on this page, 10A, will identify all officers, directors, and stockholders holding one percent or more of the shares of the respective company. Club licenses must list names of officers and directors and attach a current membership list. NAME OF CORPORATION OR CLUB COVERED BY THIS PAGE (COMPLETE ONLY IF APPLICANT OR STOCKHOLDER IS A CORPORATION OR PARTNERSHIP) HGC Holdings III, LLC Name of individual (last name first), stockholder, partner, officer or director: v. Burnett Mark A Home Street Address Number t Name P.O. Box # Municipality’ ZZ Social Security number Home telephone number Office telephone number Area Exchange Number % of business owned or controlled 0% Number of shares Check position that applies: Sole owner Partner Stockholder _v President ____ Vice-President Secretary Treasurer _¥ Director Trustee Manager Agent Executor/Administrator ____ Receiver Beneficiary Other (specify) Name of individual (last name first) Oliver James M Last Name Middle Initial Home Street Address __| Number treet Name P.O. Municipality _| State || Zip Date of birth Social Security number | Home telephone number Office telephone number rea xchange jumber % of business owned or controlled 0% Number of shares Check position that applies: Sole owner Partner Stockholder President _ Vice-President _ Secretary ____ Treasurer ____Director Trustee Manager Agent Executor/Administrator ____ Receiver Beneficiary _¥ Other (specify) Chief Operating Officer