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

Page 4 PLEASE TYPE OR PRINT ALL INFORMATION STATE ASSIGNED LICENSE NUI\4BER 4.1 0722 33 - 053 - OO1 IS THE NEAREST ENTRANCE OF THE PLACE TO BE LICENSED WTHIN 2OO FEET OF THE NEAREST ENTRANCE OF ANY CHURCH oR ScHooL? Yes { No IF THE ANSWER IS 'YES," IS A WA IVER SIGNED BY THE APPROPRIATE OFFICIAL ATTACHED TO APPLICATION? Yes No THIS 4,2 DOES THE APPLICANT INTEND TO USE ANY VEHICLES FOR THE TRANSPORT OR DELIVERY OF ALCOHOLIC BEVERAGES? YES / I'IO (A TRANSIT INSIGNIA IS NECESSARY BEFORE ALCOHOLIC BEVERAGES MAY BE TRANSPORTED.) - ANNUAL SPECIAL TAX REGISTRATION AND RETURN FORM (TTB 4.3 HAS THE APPLICANT FILED AN F 5630 5) WTH THE FEDERAL ALCOHOL AND TOBACCO TAX AND TRADE BUREAU? / No lnception of business IF'YES," DATE FILED I I 4.4 yes _ WLL ANY BUSINESS OTHER THAN-THE SALE OF ALCOHOLIC BEVERAGES BE CONDUCTED ON THE PREMISES TO BE LICENSED? I YES NO IF THE ANS\A/ER IS'YES,' INDICATE THE NATURE OF THE BUSINESS AND WHO WLL CONDUCT IT BY RESPONDING TO THE FOLLOWING QUESTIONS: - --l- Restauranl / Catering _ Hotel/Motel _ Amusements _ N.J. Lottery _ Grocery or Delicatessen y' other (specify) 4.5 { Applicant / Applicant _ Applicant _ Applicant _ Applicant _ Applicant y' Appti.rnt _ _ _ _ _ _ Other Other Other Other Other Other other Country club IF SOMEONE OTHER THAN THE APPLICANT WLL OPERATE THE OTHER BUSINESS ON THE LICENSED PREMISES, ANSWER THIS QUESTION, IF THERE IS MORE THAN ONE INDIVIDUAL OR COMPANY, ATTACH A SEPARATE PAGE LISTING THE REQUESTED INFORMATION FOR EACH OPERATOR, Business to be operated N/A Name of company/individual (Last N ame, First Name or Corporate Name) Street Address Number Municipality Zip _- Street Name State NJ Sales Tax Certificate of Authority No. .-_-.-