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

Page 6 STATE ASSIGNED LICENSE NUMBER 26bffs= g5= oR PRrtr#L rNFBdUrAroN ALL APPLICANTS ANSWER THE FOLLOWING 6.1 Yes XX No HAS THE APPLICANT EVER BEEN DENIED A LIQUOR LICENSE IN NEWJERSEY? IF THE ANSWER TO THIS QUESTION IS ^YES,'ANSWER THE FOLOWING: Retail _ Warehouse _ Type of License or Permit Denied: _ _ Wholesale Manufacturer _ Transportation Unit ofGovernment which denied License or Permit: Date of Denial (approximate it not known) _ / _ I _ Reason for Denial 6.2 HAS ANY CORPORATION, PARTNERSHIP OR INDIVIDUAL MENTIONED IN THIS APPLICATION, OTHER THAN THE APPLICANT, BEEN DENIEDA LIQUOR LTCENSE OR PERMTT? yes IF THE ANSWER IS "YES,' ANSWER THE FOLLOWING: xx No Name of Entity Last Name First Name Type of License or Permit Denied: _ _ Retail warehouse Middle lnitial Wholesale Manufacturer _ Transportation Unit ofGovernmenl which denied License - or Permit: Date of Denial (approximate if not known) _ I _t _ Reason for Denial 6.3 HAS THE APPLICANT OR ANY OTHER PERSON, CORPORATION OR ENIry MENTIONEO IN THIS LICENSE APPLICATION, OR ANYONE WITH A BENEFICIAL INTEREST IN IT, HAD AN INTEREST IN A NEW JERSEY ALCOHOLIC BEVERAGE LICENSE WHICH WAS SURRENDERED, SUSPENDED OR HADA PENALry IMPOSED IN LIEU OF SUSPENSION, NOT RENEWED, REVOKED OR CANCELLED WITHIN THE lOYEARS PRIOR TO THE DATE OF THIS APPLICATION? No lF THE ANSWER lS "YES," PROVIDE DETAILS OF EACH BELOW [Complete a separate Page 6 for each action]: Name of lndividual Last Name First Name Middle lnitial xx _Yes DATE OF ACTION I DOCKET NO PENALW WAS IMPOSED BY !ndicate whether by Divislon ofABC or identiry Local lssuing Authorityl PENALTY CONSISTED OF FINED $ NOT RENEWED [amount] SUSPENDED REVOKED CANCELLED (number of days) OTHER [explainJ 6.4 HAS THE APPLICANT OR ANY OTHER PERSON OR CORPORATION MENTIONED IN THIS LICENSE APPLICATION, OR ANYONE WITH A BENEFICIAL INTEREST IN THE BUSINESS UNDER LICENSE OR TO BE LICENSEO, EVER BEEN xx No CONVICTED OF A CRIMINAL OFFENSE? _Yes A, IF THE ANSWER IS "YES," ANSWER THE FOLLOWING: Name of lndividual Last Name Date of Birth ...-...".........._ I State Court of Jurisdiction Description of offense (specirlc charge) _l _ First Name Conviction Date_/_ Middle lnitial l_ - Disposition (Iine, penalty, etc.) Nature of interest in entity to be licensed B, lf applicable, provide the date the Director ofthe N.J. Division of

st Name Conviction Date_/_ Middle lnitial l_ - Disposition (Iine, penalty, etc.) Nature of interest in entity to be licensed B, lf applicable, provide the date the Director ofthe N.J. Division of Alcoholic Beverage Control issued an order approving or disapproving disqualilication removal . _t _l . (No license may be issued without an orde; from the Director of the Division ot niE6fi6iiE-aeiffi-c6iG6l-determining no disqualificarion or removing disqualification.) (See R.S. 33:1-3'1.2 and N.J.A.C . 13:2-15.') Provide Agency Dockel No. :[NNI- _