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

PLEASE TYPE OB PFIINT ALL INFOFIMATION Page'10A 2o2Q 33 . 027 - __qqr STATE ASSIGNED LICENSE NUMBEF ALL APPLICANTS ANSWEFI THE FOLLOWING IADD PAGES AS NECESSARY] SOLE OWNEHS AND PARTNERSHIPS: Complete the page in full. LIMITED PABTNEFSHIP: All information about a geneial parlner or partners of a limite( partnership must be reporled, whether the general parlner is an Individual or a corporalion. A list of the names and addresses of all limited partners must be subrnitted as an alachment to this application with an identification of the percentage of each limited partner as it relates to total ownership of the business entity to be licensed. COHPOBATIONS: All corporation applicants or licensees and any corporation that has an ownership inleresl in the corporation under license or to be licensed must have been reported on page 10. lnformation on this page, 10A, will identify all officers, directors, and stockholders holding one percent or more of the shares of the reSpective comp.any. Club licenses must list names of oflicers and directors and attach a current membership list- ************************************************************************ NAME OF COBPOBATTON OR CLUB COVEBED BY THIS PAGE (COMPLETE ONLY lF APPLICANT OR STOCKHOLDEF lS A coRPoRATION OFr PARTNERSHIP). Name 6f i1$yigt"l (last name tirst), stockholder, partner,.f3S"Jp% direclor: J Middle lnitial Last Name Home Street Address Number P.O. Box # State MunicipalitY zip Date ol tiirth Social Security number - Home telephone nurnber Atea (_ Office telephone number Exchange Number Exchange Number ) Area % of business owned or controlled 0 - - Number of shares Stockholder Partner Sole owner Check position that applies: Director Treasurer Secretary President X vice-eresident Receiver Executor/Administrator Agent Manager IL - rrustee - - TO ADD Itame4litividual (last name first) I Stephen Middle lnitial Last Name Home Street Address Number P.O. Box # State MunicipalitY 7in Social Security number Home telephone number Exchange Area Office telephone number Exchange Area 7o of business owned or controlled 0 Number Number Number of shares Stockholder Parlner Sole owner Check position that applies: Direclor Treasurer Secretary Vice-President President XX Trustee - Manager Receiver Executor/Administralor Agent Other (specifY) - Beneficiary . - - - -