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

Page 10A PLEASE TYPE OR PRINT ALL INFORMATION srArE ASsTcNED L rceNse Nuuaea Pa!1 33 - o)/- oal ALL APPLICANTS ANSWER THE FOLLOWNG IADD PAGES AS NECESSARY] SOLE OWNERS AND PARTNERSHIpS: Complete this page in fu[. LIMITED PARTNERSHIPS: AII 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 partner as it relates to total ownership ofthe 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. lnformation on this Page, 1OA, wili identiry all officers, directors and stockholders holding one percent ormore ofthe shares ofthe rcspective company. Club li;nses must list names of oflicers and directors and attach a current membership list. ***t*********t*l************'.**r***rt*********t**********t+*******+t********t*+***r******************************* NAME OF CORPORATION OR CLUB COVERED BY CORPORATION OR PARTNERSHIP) t @l N of individual ( ame fi I E (COMPLETE ONLY IF AP PLICANT OR STOCKHOLDER IS A Cl*b * ), stockholder, partner , officer or diredor. Last Name e Street Address Number P.O. Box#_ Municipality State z SocialSecurity Number te of Birth Home telephone numbe office terephone nunoer umber % of business omed or controlled Check position that applies: _ Number of shares _ Sole owner Presidenl _ Mce-president y' Trustee _ _ Beneficiary _ Manager _ _ _ _ Parlner Secretary _ Agent Stockholder y'rreasurer Director Executor/Administrator Other (speciry) Name of individual (last name first) , , officer or d ireclor h r't Last Name ial Home Street Address N P.O. Box#_ Receiver Street N ame Muntcipality Stale zi SocialSecurity Number Home telephone numbe te of Birth r offce telephone numOe Area Exchange N % of business owned or controlled _ _ P4sident _!! Trustee _ -/. _ Beneficiary _ Check position that applies: Number of shares Sole owler Vice-president Manager Other

hone numOe Area Exchange N % of business owned or controlled _ _ P4sident _!! Trustee _ -/. _ Beneficiary _ Check position that applies: Number of shares Sole owler Vice-president Manager Other (specify) artner _ -P _Agent Secretary _ _ _ Stockholder Treasurer Executor/Administrator _ _ Direclor Receiver