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

Page 6 PLEASE TypE OR pRtNT ALL TNFORMATTON STATE ASS|GNED LTCENSE NUMBER 0722 _ 33 _ 053 _001 ALL APPLICANTS ANSWER THE FOLLOWNG 6,1 HAS THE APP LICANT EVER BEEN DENIED A LIOUOR LICENSE IN NEW JERSEY? y' tto Yes IF THE ANSWER TO THIS OUESTION IS'YES', ANSWER THE FOLLOWNG: rvpe or License or Permit Deniedr Y"irx;ur""i;;;rt"n"oon'"on =ffij?J*^"N/,{- Unit of Governmenl which denied License or Permit: Date of Denial (approximate, if not known) _ t _l _ Reason for Denial 6,2 HAS ANY CORPORATION, PARTNERSHIP, OR INDIVIDUAL I\4ENTIONED IN THIS APPLICATION, OTHER THAN THE APPLICANT, BEE-N DENIED A LIQUOR LICENSE OR PERMIT? / _Yes ruo IF THE ANSWER IS 'YES', ANSWER THE FOLLOWNG: Type of License or Permit Denied: _ Retail _ Wholesale _Transportatjon _ Warehouse _ l\4anufacturer Unil of Government which denied License or permit: N/A Date of Denial (approximate, if not known) _ I _ t _ Reason for Oenial 6,3 HAS THE APPLICANT OR ANY OTHER PERSON, CORPORATION OR ENIITY MENTIONED IN THIS LICENSE APPLI, CATION, OR ANYONE WIH A BENEFICIAL INTEREST IN IT, HAD AN INTEREST IN N ruEWICNSEV EiCbiOiib BEVERAGE LICENSE WHICH WAS SURRENDERED, SUSPENDED OR HAD A PENALTv rrrltpOSeO rr'r r-reu,oi SUSPENSION, NOT RENEWEO. REVOKED OR CANCELLED WIHIN THE 10 YEARS PRIOR TO THE DAiE OF THIS APPLICATION? No / rF THE ANSWER rs "yES" pRovrDE DETATLS oF EAcH BELow (comprete a separale page tor each action): -ves Name of individual N/A Last Name DOCKET NO DATE OF ACTION Firsl Middle lnitial PENALTY WAS IMPOSED BY (indicate whelher by Div. ABC or identify Local lssuing Authority) PENALTY CONSISTED OF: NOT RENEWED SUSPENDED REVOKED - (no. of days) _ 6 FINED S OTHER (explain) CANCELLED - 4 HAS THE APPLICANT OR ANY OTHER PERSON OR CORPORATION I\4ENTIONED IN TFII S LICENSE APPLICATIOIT OR ANYONE WITH A BENEFICIAL INTEREST IN THE BUSIN ESS UNDER LICENSE OR TO BE LICENSED CONVICTED OF A CRIMINAL OFFENSE? EVER BEEN -L-No IS "YES", A, IF THE ANSWER ANSVVER THE FOLLOWNG: -Yes Name of individual N/A Date of Birth I Last Name I First Conviction Stale Dale Middle lnrlial I court ofjurisdiction Oescription of offense (specific charge) Disposition (fine, penalty, etc.) Nalure of interest in entity lo be licensed B lf applicable, provrde the dale lhe Direclor of NJ Division ofAlcoholic Beverage control issued an order approving or

Disposition (fine, penalty, etc.) Nalure of interest in entity lo be licensed B lf applicable, provrde the dale lhe Direclor of NJ Division ofAlcoholic Beverage control issued an order approving or disapprovrng disqualification removal: / (No license may be issued with;ut an orae, trom rt o,ie"toi"oir"ii" / oini"[["r" Beverage Control determining no disqualitlcation or removing disquallfication. (See N.J.S A 3311-3j.2 " an; N JA. C.- lZ'i1s1. - - Provide Agency Docket No. : (NN)- -.