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

9 Page PLEASE TYPE OR PRINTALL INFORMATIoN STATE ASSTGNED LTCENSE NUMBER 0722 - 33 _ 053 _ 001 ALL APPLICANTS ANSWER THE FOLLOWNG 9,1 DOES ANY INDIVIDUAL, PARTNERSHIP, CORPORATION, OR ASSOCIATION OTHER THAN THE APPLICANT HAVE AN INTERESI DIRECTLY OR INDIRECTLY IN THE LICENSE APPLIED FOR OR IS THE STOCK OF ANY STOCKHOLDER HELD IN ESCROWOR PLEDGED IN ANY WAY? -{-llo IF THE ANSWER IS "YES', ANSWER THE FOLLOWNG, USING A SEPARATE PAGE 9 FOR EACH INDIVIDUAL OR CORPORATION OF INIEREST, ATTACH A SEPARATE PAGE OF EXPLANATION IF MORE SPACE IS NEEDED, -ves Name of individual (Last Name First) or Co|poration N/A SocialSecurity number (Lasl Name, First Name, Middle tniiiat or Corporate Name) or _-_-_ NJ Sales Tax Certificate ofAuthority No. Street Add ress Number Street Name P.O. Box # Municipality State zip Describe Nature of lnterest -- 9,2 DOES ANY INDIVIDUAL, PARTNERSHIP, CORPORATION, OR ASSOCIATION HOLO ANY CHATTEL MORTGAGE OR CONDITIONAL BILL OF SALE OR OTHER SECURITY INTEREST ON ANY FURNITURE, FIXTURES, GOODS OR EQUIPI\,IENT TO BE USED IN CONNECTION WTH THE BUSINESS TO BE OPERATED UNDER THE LICENSE APPLIED FOR? y' uo IF THE ANSWER IS "YES', ANSWER THE FOLLOWNG USING A SEPARATE PAGE 9 FOR EACH INDIVIDUAL OR CORPORAIION OF INTEREST. ATTACH A SEPARATE PAGE OF EXPLANATION IF MORE SPACE IS NEEDED. -ves Name oI individual (Last Name First) or Corporalion N/A (Last Name, First Name, Middle lnitial or Corporate Name) SocialSecurity number -_-_ or NJ Sales Tax Certificate ofAuthorily No. Street Address Number P.O. Box # Sl reel Name Municipality Stale zip Describe Nature of lnterest 9.3 HAS THE APPLICANT AGREED TO PERMIT ANYONE NOT HAVING AN O\ATNERSHIP INTEREST IN THE LICENSE TO RECEIVE OR AGREED TO PAY ANYONE (BY WAY OF RENT, SALARY, OR OTHERWSE) ALL OR ANY PERCENTAGE OF THE GROSS RECEIPTS OR NET PROFIT OR INCOME DERIVED FROM THE BUSINESS TO BE CONDUCTEO UNDER THE LICENSE APPLIED FOR? -!a-No IF THE ANSWER IS "YES', ANSWER THE FOLLOWNG, USING A SEPARATE PAGE 9 FOR EACH INDIVIDUAL OR CORPORATION OF INTEREST. ATTACH A SEPARATE PAGE OF EXPLANATION IF MORE SPACE IS NEEOED, -Yes Name of individual (Last Name Firsl) or Corporation N/A SocialSecurity number _-_-_ (Last Name, First Name, Middle lnitial or Corporate Name) or NJ Sales Tax Cerlificale ofAuthority No Street Address Number P.O. Box # zp Sl reel

l) or Corporation N/A SocialSecurity number _-_-_ (Last Name, First Name, Middle lnitial or Corporate Name) or NJ Sales Tax Cerlificale ofAuthority No Street Address Number P.O. Box # zp Sl reel Name Municipality State __ Describe Nature of lnlerest APPLICANTS THAT ARE SOLE PROPRIETORS OR PARTNERSHIPS GO TO PAGE 1OA. CORPORATIONS COMPLETE PAGE 1O