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

Page 10A PLEASE TYPE OR PRINT ALL INFORMATION sTATEAssTcNEDLToENsENUMBER /7rJ: Sl - <rti -_OlL ALL APPLICANTS ANSWER THE FOLLOWING [ADD PAGES AS NECESSARY] SOLE OWNERS AND PARTNERSHIPS: Complete this page in tu . 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 ofeach limited partner as it relates to lotal owlership 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, wila identify all officers, directors and stockholders holding one percenl ormore oflhe shares ofthe respeclive company. Club licenses must list names of officers and directors and attach a current membership list. **t********t*************tt************t********* *******************'l************* NAME OF CORPORATION OR CLUB COVERED BY THIS PAGE PLETE ONLY IF APPLI R STOCKHOLDER IS A CORPORATION OR PARTNERSHIP) ^t of ind ividual (last name first), stockholder, partn rord /o c'tor Last Name o StreetAddre Number P.O.Box#_ Municipality State zt So"i"r S""rrity lf rrnO"r. Birth - Home telephone numOer Office telephone number Area Exchange Num % of business owled or controlled Check position that applies: _ _ Sole President artner Secretary Manager _Agent _ _ _ Stockholder Treasurer Director Executor/Administratol Receiver r)thEr /<m.itu\ Bcncficierv _ of individua owter _p Vice-President _ y' frustee _ -,/ _ Number of shares last name fi ) , stockholder, partner, officer or dire clor J lq-o Last Name Home Street Address Number P.O. Box # Municipality State zi o"t"otaia Social Security Number Home telephone number Area Number Office telephone num bet Area Exch Number % of business owned or controlled Check position that applies: _ _ President _ Arustee _ Number of shares Sole o\irner Vice.President Manager Beneficiary _ - Other

um bet Area Exch Number % of business owned or controlled Check position that applies: _ _ President _ Arustee _ Number of shares Sole o\irner Vice.President Manager Beneficiary _ - Other (specify) _ _ _ Partner Secretary Agent _ _ _ Stockholder Treasurer Director Executor/Administrator Receiver