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

Page 10A PLEASE TYPE OR PRINT ALL INFORMATION srArE ASSTGNED LrcENsE NUMBER /l f- % - U.{ __oil o - ALL APPLICANTS ANSWER THE FOLLOWNG IADD PAGES AS NECESSARY] SOLE OWNERS AND PARTNERSHIPS: Comptere this page in fu . LIMITED PARTNERSHIPS: 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 ofthe percentage of each limited parlner as it relate; to btal ownership of the business entity to be licensed. coRPoRATloNs; All corporation applicants or license€s 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, 1oA, wili identity all officers, directors and stockholders holding one percent ormore ofthe shares ofthe respec{ive company. club li;nses must list names of officers and directors and attach a currenl membership list. ******t*t****lrt*************'l'r****rttt*******fa*t*******t*t*******talr******ttit*******i***************r************:r NAME OF CORPORATION OR CLUB COVERED BY CORPORATION OR PARTNERSHIP) Name of individual (la c IS PAGE (COMPLETE ONLY IF APPLICANT OR STOCKHOLDER IS A &r name first), stockholder, partner, offce directot. F Last Name Address Number P.O. Box #_ Municipatity State zip Social Security Nu Home telephone n -a* uno office telephone num "orBirrh o., Number % of business owned or controlled Number ofshares _Sole owner _ Vice-president Secrelary _ _ _ TPresident Manager _Agent _ --gl trustee _ Beneficiary _ Other (specify) - Check position that applies: pa me of individual (last name first) , stockholder, partner, officer or di 1 Stockholder _ Treasurer Execrlor/Administrator Oirector Receiver e r: Last Name ome Street Address Number P.O. Box # zip Municipality - State _ .o,r"'i"*r',r rurro"n of Birth Home telephone numb Office te,ephone number Exchange o/o _ P/esident _ _ _l7lTrustee _ _ Beneficiary _ Check position that applies: Number d of business owned or controlled Number of shares Sole owner Partner _ Vice-president Secretarv _Treasurer Direc{or _ Receiver _Agent Other

iciary _ Check position that applies: Number d of business owned or controlled Number of shares Sole owner Partner _ Vice-president Secretarv _Treasurer Direc{or _ Receiver _Agent Other (specify)_ Manager Stockholder Executor/Administralor