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

PLEASE TYPE OR PBINT ALL INFORMATION Pagq 10A 2o2Q 33. 027-_!![ STATE ASSIGNED LICENSE NUMBER ALL APPLICANTS ANSWER THE FOLLOWING IADD PAGES AS NECESSARY] SOLE OWNERS AND PARTNEHSHIPS: Complete the page in full. LIMITEO PAFTNEBSHIP: All information about a geneial partner or parlners of a limited partnership must be reported, whether the general partner is an individual or a corporalion. A list of the names and addresses of all limited parlners must be submitted as an a[achment to this application with an identification of the percentage of each limited partner as it relales to total ownership of the business entity to be licensed. COBpORATIONS: All corporation applicants or licensees and any corporation that has an ownership inlerest in lhe corporation under license or to be licensed must have been reported on page 10. lnformation on this page, 10A, will identify all oflicers, directors, and stockholders holding one percent or more of the shares of the reSpective company. Club licenses must lisl names of officers and direclors and attach a current membership list. ************************************************************************ NAME OF COBPORATION OR CLUB COVEBED BY THIS PAGE (COMPLETE ONLY IF APPLICANT OR STOCKHOLDER IS A CORPORATION OR PARTNERSHIP). Name ol individual (last name lirst), stockholder' p artner, officer or director: Peter Arbes T Middle Initial First Last Name Home Street Address Streel Name Number P.O. Box # State MunicipalitY a\^ Date or Social Security - number birth Home telephone number Otfice telephone number Area Number of shares 0 Stockholder Parlner Director Treasurer Secretary - Sole owner Check position that applies: Vice-President President Agent Trustee - Manager - Executor/Administrator - Receiver - - - - Number Exchange 0 % of business owned or controlled Ia - Number Exchange Area TO ADD Name pl infvidut[r.", name first): p. Wallace Middle lnitial First Last Name Horne Street Address Name Number P.O. Box fl State MuniciPalitY 7i Date of birth Social Security number - Home telephone number Office telephone number Area Exchange Number At* Exchange Number 0 Number of shares of business owned or controlled Stockholder Partner Sole owner Check position tfiat applies: Direclor president Treasurer 2C

e number Area Exchange Number At* Exchange Number 0 Number of shares of business owned or controlled Stockholder Partner Sole owner Check position tfiat applies: Direclor president Treasurer 2C Secretary Vice-President xX Receiver Executor/Administralor Agent - Truslee - Manager 0 o/o Other (sPecifY) - Beneficiary . - - - -