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

Page 9 PLEASE TYFE OR PRINTALL INFORMATION STATE ASSIGNED LICENSE NUMBER ALt APPLICANTS ANSWER THE FOLLOWNG 9.1 DOES ANY INDIVIDUAL, PARTNERSHIP, CORPORATION OR ASSOCIATION OIIEBIHANIEESPPT I HAVE AN INTEREST DIRECTLY OR INOIRECTLY IN THE LICENSE APPLIED FOBIOR IS THE STOCK OF ANY STOCKHOLOER HELO IN ESCROWOR PLEDGED IN ANYWAY? -Z:- No IF THE ANSWER IS'YES,'ANSWER THE FOLLOWNG USINGA SEPARATE PAGE 9 FOR EACH INDIVIDUAL OR CORPOFATION OF INTEREST, ATTACH A SEPARATE PAGE OF EXPLANATION IF MORE SPACE IS NEEDED, -Yes Name of lndividual (Last Name FiBt)or Corporalaon (Lasl Name. FiBl Name l,liddle lnilialor Co@orate Name) ---- SocialSecunty Number oR NJ Sales Tax Cedificate olAuihonly Number Slreel Address P.o. Box# _ Number Slreel Name Stale zip oescribe Nalurc of lnteresl 92 DOESANY INDIVIOUAL. PARTNERSHIP. CORPOFIATION ORASSOCIATION HOLDANY CHATTEL I'4ORTGAGE OR CONDTTIONAL BILL OF SqLE OR OTHER SECURITY INTEREST ON ANY FURNITURE, FIXTURES, GOODS OR EOUIPMENT TO BE USED IN CONNECTION WTH THE BUSINESS TO BE OPERATEO UNDER THE LICENSE APPLIEo FoR? --jl lo IF THE ANSWER IS'YES,'ANSWER THE FOLLOWING USING A SEPARATE PAGE 9 FOR EACH INDIVIDUAL OR CORPORATION TO BE REPORTED, ATTACH A SEPARATE PAGE OF EXPLANATION IF MORE SPACE IS NEEDED, -ves Name of lndividual (Last Nam€ First) orColpor3lion SocialSecudty Number- (Lasl Name, First Name, Middle lnitial or Corpolate Name) NJ Sales Tax Certficate olAulhonly P.O. Box NJmber- Numbff #- Slreet Name Muniopalilv -oR Siate zip Descflbe Nalure ol lnteEst 9,3 HAS THEAPPLICANIAGREEDTO PERMITANYONE NOT HAVINGAN OW{ERSHIP INTEREST IN THE LICENSETO RECEIVE ORAGREEDTO PAY ANYONE (8Y WAY OF RE}T. SALARY OROTHERWSE}ALL OR ANY PERCENTAGE -' oF THE GROSS RECEIPTS OR NET PROFIT OR lNc9tr E OERIVEO FROM THE AUSINESS TO BE CONDUCTED UNOERTHE LICENSEAPPLTED FOR? -:- No IF THE ANSWER IS 'YES,'ANSWER THE FOLLOWNG USING A SEPARATE PAGE 9 FOR EACH INDIVIOUAL OR -Yes CORPORATIONTO BE REPORTED, ATTACH A SEPAPATE PAGE OF EXPTANATION IF MORE SPACE IS NEEOED' Name of lndividual(Lasl Name FiBo o. Corporation - --oR Social Secunty Number - NJ Sares Tax Cenrl'cale of Aurhonty Numbe.- Numb€r Slrcei Namo - Munidpaliry-- P.O. Box* State zip Describe Nature of lnteresl - APPLTCANTS THAT ARE SOLE PROPRIETORS OR PARTNERSHIPS GO TO PAGE 1OA, CORPORATIONS AND LIMITED LIABILIry COMPANIES COIIIPLETE PAGE

- Munidpaliry-- P.O. Box* State zip Describe Nature of lnteresl - APPLTCANTS THAT ARE SOLE PROPRIETORS OR PARTNERSHIPS GO TO PAGE 1OA, CORPORATIONS AND LIMITED LIABILIry COMPANIES COIIIPLETE PAGE 10, -' - -