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

PLEASE TYPE OR PR]NTALL INFORI"IATION Page 5 srArE A.STGNED LrcENs . *urr.* W33-- Ul- 0o I ALL APPLICANTS ANSWER THE FOLLOWNG 5,1 IS THE APPLICANT OR ANY OTHER PERSON i./]ENTIONED IN THIS APPLICATION A POLICE OFFICER OR HOLD ANY POSITION ENTRUSTED WTH THE ENFORCEMENT OF ANY LAWS CONCERNING ALCOHOLIC BEVERAGES IN ANY IIIANNER WI]ATSOEVER? Yes ll No lf the answer rs "Yes," complete the followng. Name of individual Last Name Firsl Name Middle lnitial Title of posilion held Name of Employing Agency 5.2 DOES THE APPLICANT OR ANY OTHER PERSON MENTIONED IN THIS APPLICATION, OR ANY PERSON HAVINGA BENEFICIAL INTEREST IN THE LICENSED BUSINESS, HOLD OFFICE IN THE UNIT No OF GOVERNMENT ISSUING THE LICENSE? Yes IF THE ANSWER IS 'YES.' COMPLETE THE FOLLOWNG Name of lndividual Firsl Name Last Name lladdle lnitial Titre cl Ofice Municipalrty 5,3 DOES THE APPLICANT OR ANY OTHER PERSON I\4ENTIONED IN THIS LICENSE APPLICATION, OR ANYONE WITH A BENEFICIAL INTEREST IN THE LICENSED BUSINESS, DIRECTLY OR INDIRECTLY, HAVEANY INTEREST IN ANY BREWERY, WNERY, DISTILLERY, RECTIFYING AND BLENDING PLANT, II\,IPORTER OR W}IOLESALE ALCOHOLIC BEVERAGE BUSINESS, AS OWNER, PART OWNER, LANDLORD. TENANT, MORTGAGE HOLDER OR AS A STOCKHOLDER, OFFICER, DIRECTOR, AGENT, EMPLOYEE OR OTHERWSE? No IF THE ANSWER IS "YES,'ATTACH AN AFFIDAVIT EXPLAINING THE RELATIONSHIP AND NATURE OF THE INTEREST AND COMPLETE THE FOLLOWNG: A New Jersey license number, ifapplicable B, IF THE BUSINESS SQESI9I HOLD A NEWJERSEY LIQUOR LICENSE, ANSWER THE FOLLOWNG OUESTIONS: Name ofentity conducting business (Corporalion, Partnership or lndividual) (Last Name, First Name, lvliddle lnitialor Corporate Name) SlreetAddress Number P.O. Box #_ I\,,lunicipality zip Type of Business -- - State