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

Page 5 PLEASE TYPE OR PRINT ALL INFORMATION STATE ASSIGNED LICENSE NUMBER 0722 . 33 053 - 001 ALL APPLICANTS ANSWER THE FOLLOWNG 5.1 IS THE APPLICANT OR ANY OTHER PERSO.N MENTIONED IN THIS APPLICATION A POLICE OFFICER OR HOLD ANY POSITION ENTRUSTED WTH THE ENFORCEMENT-F ANV'L,qWi i5TICCNNITG ALCOHOLIC BEVERAGES IN ANY IUANNER WHATSOEVER? / t'to lf the answer is "Yes", complele the following -ves Name of individuat N/A Last Name First lvliddle lnitial Title of position held Name of Employing Agency 52 DOES THE APPLICANT OR ANY OTHER P.EXSON MENTIONED IN THIS APPLICATION, OR ANY PERSON HAVING A BENEFICIAL INTEREST IN THE LICENSEO EUSTNCSS ATL'drrICir'r.i'iXi UNIT OF GOVERNMENT ISSUING THE LTCENSE? r.ro _yes / IF THE ANSWER IS "YES", COMPLETE THE FOLLOWNG: Name of individual N/A Last Name Firsl Middle lnatial Title of office [Iunicipality 5'3 DOES THE APPLICANT OR ANY OTHER P.EXSON MENTIONED IN THIS LICENSE APPLICATION, OR ANYONE *,TH A BENEFICIAL INTEREST IN THE LIC.EI]SED BUSINE'S, iUOrNECrr.V, HAVE ANY INTEREST IN ANY BREWERY, WNERY, DISTILLER. RECTIFYING AND BLE NbiNE P-r-Er,r-i, iUPONTCN OR WHOLESALE ALCOHOLIC BEVERAGE BUSINESS, AS O!\4{ER, PART OWNER, LANDiORD, iit.rir.rr, T"TONTCNCE HOLDER, OR AS A STOCKHOLDER. oFFtCER. DtRECTOR. AGENT. eUpLovee, on DiRi'iii,di / oiriiiwrl'!:i No IF THE ANSWER IS 'YES'ATTACH AN AFFIDAVIT EXPLAINING THE RELATIONSHIP AND NATURE OF THE INTEREST -Yes A. New Jersey license number, if applicable B, IF THE BUSINESS DOES NOT HOLD A NEW JERSEY LIQUOR LICENSE, ANSWER THE FOLLOWNG AND COMPLETE THE FOLLOWNG: Name of entjly conducting business (Coporation, parlnershjp N/A OUESTIONS or lndividual) (Last Name, First N ame, o. Corporate Namej Street Address Number P.O. Box # Zio Type of Business Municipality Street Name State