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

PLEASE TYPE OR PRINTALL INFORMATION Page 5 STATE ASSIGNED LICENSE NUI\,IBER --- ALL APPLICANTS ANSWER THE FOLLOWNG 5,1 IS THE APPLICANT OR ANY OTHER PERSON MENTIONED IN THIS APPLICATION A POLICE OFFICER OR HOLD ANY POSITION ENTRUSTED WTH THE ENFORCEIIENT OF ANY LAWS CONCERNING ALCOHOLIC BEyr."\G ES IN ANY II4ANNER WHATSOEVER? tNo lf the answer is'Yes,'complete the following: Name ofindividual Last Name First l.far"e ltliddle lrlitld Tille of oosrtion held Name of Employing Agency 5_2 OOES THE APPLICANT OR ANY OTHER PERSON MENTIONED IN THIS APPLICATION, OR ANY PERSON HAVINGA BENEFICIAL INTEREST lN THE LICENSEIdUSINESS, HOLD OFFICE lN THE UNlr No OF GOVERNMENT ISSUING THE LICENSE? "- IF THE ANSWER IS 'YES,' COT.IPLETE THE FOLLOWNG: -Yes Name of lndividual [Iiddle lnilial Last Name Title of Offco Municipality 5.3 DOES THE APPLICANT OR ANY OTHER PERSON MENTIONEO IN THIS LICENSE APPLICATION, OR ANYONE WTH A BENEFICIAL INTEREST IN THE LICENSED BUSINESS, DIRECTLY OR INDIRECTLY, HAVEANY INTEREST IN ANY BREWERY, WNERY, DISTILLERY, RECTIFYING AND BLENDING PLANT, IMPORTER OR VVIIOLESALE ALCOHOLIC BEVERAGE BUSINESS, AS OWNER, PART OVI/I.IER, LANOLORD, TENAryT, I\4ORTGAGE HOLDER OR AS A STOCKHOLDER, OFFICER, DIRECTOR, AGENT, EMPLOYEE OR g)fHERWlSE? Yes No IF THE ANSWER IS'YES,'ATTACH AN AFFIDAVIT EXPLAINING THE RELATIONSHIP ANO NATURE OF THE INTEREST ANO COMPLETE THE FOLLOWNG: A. New Jersey license number, if applicable B. IF THE BUSINESS gSEgNqt HOLD A NEWJERSEY LIOUOR LICENSE, ANSWER THE FOLLOWNG OUESTIONSI Name oI entity conducting business (Corporation, Partnership or lndividual) (Last Name, Firsl Name, iddle lnitial or Corporate Name) SlreetAddress Streel Name Number Municipalily P.O. Box # zip Type of Business - State _