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

Page 7 PLEASE TYPE OR PRINT ALL INFORMATION STATE ASSIGNED LICENSE NUMBER 1802. 33. 005. (012 wa ALL APPLICANTS OTHER THAN CLUB LICENSE ANSWER THE FOLLOWING DOES THE APPLICANT, A MEMBER OF THE APPLICANT'S IMMEDIATE FAMILY (SPOUSE, CHILDREN, PARENTS, IN-LAWS OR SIBLINGS) OR ANY PERSON WITH A BENEFICIAL INTEREST IN THE SUBJECT LICENSE OF THIS APPLICATION, HAVE ANY INTEREST IN ANY OTHER NEW JERSEY ALCOHOLIC BEVERAGE LICENSE? v_ Yes No IF THE ANSWER IS “YES,” COMPLETE THE FOLLOWING BY LISTING THE NEW JERSEY LIQUOR LICENSE TWELVE DIGIT NUMBER(S) AND THE NAME(S) OF THE PERSON(S) OR CORPORATION(S) WHO HOLD(S) SUCH INTEREST. USE ADDITIONAL PAGE(S) 7 AS NEEDED. A. License Number __2013 -__ 33 -__ 013 -__ 004 Name __HGC Shackamaxon, LLC (Scotch Plains) (Last Name, First Name, Middle Initial or Corporate Name) Relationship to Applicant __Sister Company FHSS USES OI a III I III TI I I I I III II IIIT IT ITT TI TT TTT II IIIT I ITI IIS III SISSIES ISITE B. License Number _ 1022 -_33 -_001 - _005 Name _ HGC Stanton Ridge, LLC (Readington Township) (Last Name, First Name, Middle Initial or Corporate Name) Relationship to Applicant __Sister Company TESS ISAO ESI IOI II II III TTI IT I I I III I III ITI IAD ASI STIS IIIS ISIS IIIA SSIS SSSI SSSI ISIS SS SSSI STA C. License Number - 2 « Name (Last Name, First Name, Middle Initial or Corporate Name) Relationship to Applicant TEE HEHE SEH SOI SUSI III III III ITI II IIT IIIT I TE III III ITI III I IIIT III IIIA STASIS SASSI IIIA IT ITI ASSIS IIIA, 7.2 WOULD ANY PERSON OR CORPORATION NAMED IN THIS APPLICATION FAIL TO QUALIFY FOR OWNERSHIP OF THE LICENSE IF APPLYING AS AN INDIVIDUAL BECAUSE OF AGE, CRIMINAL CONVICTION OR PROHIBITED INTERESTS IN OTHER LICENSES? Yes _¥__No IF THE ANSWER IS “YES,” ANSWER THE FOLLOWING BY INSERTING THE NAME OF THE INDIVIDUAL OR CORPORATION AND THE SOCIAL SECURITY NUMBER AND DATE OF BIRTH, IF AN INDIVIDUAL. USE ADDITIONAL PAGE(S) 7 AS NEEDED. Name (Last Name, First Name, Middle Initial or Corporate Name) Social Security Number - - OR NJ Sales Tax Certificate of Authority No. Date of Birth I /