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

PLEASE TYPE OR PRINT ALL INFORMATION Page 5 STATE ASSIGNED LICENSE NUMBER 2020 33 027 002 ALL APPLICANTS ANSWER THE FOLLOWING - -- 5,1 IS THE APPLICANTOR ANY OTHER PERSON MENTIONED IN THIS APPLICATION A POLICE OFFICER OR HOLD ANY POSITION ENTRUSTED WITH THE ENFORCEMENI OF ANY LAWS CONCERNING ALCOHOLIC BEVERAGES IN ANY i.TANNER WHATSOEVER? ves -]]- rlo lfthe answer is "Yes," complete the following: -Name of individual First Name Last Name Middle lnitial Title of position held Name of Employinq Agency DOES THE APPLICANT OR ANY OTHER PERSON MENTIONED IN THIS APPLICATION, OR ANY PERSON HAVING A BENEFICIAL INTEREST IN THE LICEN.qED BUSINESS, HOLD OFFICE IN THE UNIT Yes No OF GOVERNMENT ISSUING THE LICENSE' -:L IF THE ANSWER IS 'YES,' COMPLETE THE FOLLOWING: - Name of lndivdual First Name Last Name Middle lnitial Title of Otrice l\4unicipality 5.3 DOES THE APPLICANT OR ANY OTHER PERSON MENTIONED IN THIS LICENSE APPLICATION, OR ANYONE WITH A BENEFICIAL INTEREST IN THE LICENSED BUSINESS, DTRECTLY OR INDIRECTLY, HAVE ANY INTEREST IN ANY BREWERY, WINERY, DISTILLERY, RECTIFYING AND BLENDING PLANT, IMPORTER OR WHOLESALE ALCOHOLIC BEVERAGE BUSINESS, AS OWNER, PART OWNER, LANDLORD, TENANT, MORTGAGE HOLDER OR AS A STOCKHOLDER, OFFICER, DIRECTOR, AGENT. EMPLOYEE OR OTHERWISE? Yes xx No IF THE ANSWER IS "YES,'ATTACH AN AFFIDAVIT EXPLAINING THE RELATIONSHIP AND NATURE OF THE INTEREST AND COMPLETE THE FOLLOWNG: A. New Jersey license number, ifapplicable B, IF THE BUSINESS DOES ILO] HOLD A NEW JERSEY LIQUOR LICENSE, ANSWER THE FOLLOWING OUESIIONS Name of entiv conducting business (Corporation, Partnership or lndividual) (Last Name, First Name, Middle lnitialor Corporate Name) Street Address Street Name Number PO Box # zip Type of Business Irunicipality State _