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 rrrur,reen /,Iora - o)t' - oo t ALL APPLICANTS ANSWER THE FOLLOWNG IADD PAGES AS NECESSARY] SOLE OWNERS AND PARTNERSHIPS: Complete 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 ofeach 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 lhe corporation under license or to be licensed must have been repo(ed on Page 'lO. lnformation on this Page, 1OA, will identify all officers, directors and stockholders holding one percent or more oflhe shares ofthe respeclive company. Club licenses must list names of officers and directors and attach a current membership list. ****t************t*********!r******t*t*****************t NAME OF CORPORATION OR CLU B COVERED BY CORPORATION OR PARTNERSHIP) ame of individ '7 a S PAGE (co MPLETE ONLY IF APPLI , stockholder, partner, name fi NT OR STOCKHOLDER IS A or dire Last me Home Street Address Number P.O. Box # Municipality State zt Social security Numb. DareorBir Home telephone numOer Office telephone numoe Area Excha nge % of business owned or controlled _ PJ€sidenl ,r/ Truslee -/ _ Beneficiary _ - Check position that applies: e of individual (la .\ Sole owner _ Vice-President Manager Other (specify) b Number Number of shares Partner Secretary _Agent - first) , stockholder, partner, _ _ _ Stockholder Treasurer Executor/Administrator _ _ Receiver _ _ Receiver Oireclor r or director: Last N e Street Address Number P.O.Box#_ Municipality State zi SocialSecurity Number Oate of Birth Home telephone number Office telephone number ( _ ) Area Exchange Number % of business owned or controlled _ Pretident L/Trustee _ --.. Beneticiary _ _ Check position that applies: Sole owner ra Number of shares Partner Vice-President Secretary Manager Agent Other (speciry) _ _ _ Stockholder Treasurer Executor/Administrator Direc{or