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

Page 10A PLEASE TYPE OR PRINT ALL INFORMATION srArEASSTGNED Lrceruse rurt,raen /zio,i- -li - _94- _!_9J ALL APPLICANTS ANSVVER THE FOLLOWNG IADD PAGES AS NECESSARY] SOLE OWNERS AND PARTNERSHTPS: Complete this page in fu . LIMITED PARTNERSHIPS: All information about a general parlner or partners ofa limited partnership must be reported, whelher 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 omership of the 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 musl have been reporled on Page 10. information on this Page, 1OA, wili identiry all officers, directors and stockholders holding one percent or more ofthe shares ofthe respeclive company. Club li&nses mus isl namesof oflicers and direclors and attach a current membership list. ***************t***********t*********t*********'tt*******tt*ttt***!r*ttti********+t**********t*********************** NAME OF CORPORATION OR CLUB COVERED BY CORPORATION OR PARTNERSHI SP (COMPLETE ONLY IF APPLICANT OR STOCKHOLDER IS A A.r ame of individual (last name first), stockholder, partner officer or di l: \ALast Name ome Street Address "b ftl iddle lnitial N P.O. Box #_ Municipa zie oateofgin Social Security Number Home telephone nunoer Area Oflice telephone number ( _ Exchange Number Exchange Number ) Area % of business owned or controlled Check position thal applies; _ _ Sole owner P/esident _ Vice-President i ./ f ruslee _ Manaoer Beneficiary _ / Number of shares Partner _ _ _ Secretary Agent Stockholder Treasurer _ Executor/Administrator _ _ Receiver _ _ Receiver Direclor Other (specify) (r) irldfie of individual (l ast name fi rst) , stockholder, partner, cer or director: Last Name me Street Address Num P.O. Box # Municipaljty State zi9 *3 " Home telephone numoe Social Security N oflice tetephone num Date of Birt *, Area Number % ol business owned or controlled Check position that applies: _ _ _ Number of shares Sole owter Partner Stockholder President _ Mce-President Secretary Treasurer Trustee

*, Area Number % ol business owned or controlled Check position that applies: _ _ _ Number of shares Sole owter Partner Stockholder President _ Mce-President Secretary Treasurer Trustee _ Manager Beneficiary dner lspeotyy - Executor/Ad inistrator Direclor