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

Page 10A . 2Pd{r6sE STATE ASSIGNED LICENSE NUI\,4BER lPj: oR Pt!}ALL rUbTMAroN ALL APPLICANTS ANSWER THE FOLLOWING [ADD PAGES AS NECESSARY] SOLE OWNERS AND PARTNERSHIPS: Complete this page in full LIMITED PARTNERSHIPS: All information about a general partner or partners of a limited partnership must be reported, whether the general partner is an individual or a corporation. A list of the names and addresses of all limited parlners must be submitted as an attachment to this application with an identification ofthe percentage ofeach limited partneras it relates to total o!,vnership ofthe business entity to be licensed. CORPORATIONS: All corporation applicants or licensees and any corporation that has an ownership interest in the corporation under license or to be licensed musl have been reported on Page '10. lnformation on this Page, 10A, will identiry all officers, directors and stockholders holding one percentormore ofthe shares ofthe respective company. Club licenses must lisl namesofofficers and directors and attach a current membeFship list. TO ADD t*+***++****!t**+******++*****************************************t*t****************************+++t+***********t NAME OF CORPORATION OR CLUB COVERED BY THIS PAGE (COMPLETE ONLY IF APPLICANT OR STOCKHOLDER IS A CORPORATION oR PARTNFRSHIP), l0 ADD Name of individual (last name tirst), stockholder, partner, officer or direclor Meus Richard Last Name Middle lnitial Home Streel Address Number P.O.Box#_ Street Name Municipality State E-Mail Address zip Date of Birt Social Security Numbe Home telephone number - office telephone nu.u", Area 7o of business owned or controlled _ _ President _ _;91_Trustee _ _ Beneficiary _ Check position that applies: Number 0' Sole owner Vice-President Manager Number of shares _ _ _ 0 Partner Stockholder Secretary Treasurer Darector Agent Executor/Adminislrator Receiver Other (speciry) Name of individual (last name first) , stockholder, partner, officer or director: Walsh Michae I Middle lnitial Last Name Home Street Address Street Name Number P.O. Box # Stat Municipality E-MailAddress zip Social Security Num6g Date of Birt Home telephone number Area Offlce telephone number ( _ ) Area Exchange Number Exchange Number Check position that applies. _ Number of shares 0 0 70 of business owned or controlled Sole

t Home telephone number Area Offlce telephone number ( _ ) Area Exchange Number Exchange Number Check position that applies. _ Number of shares 0 0 70 of business owned or controlled Sole owner Vice-Presidenl President _ _ xx Trustee _ Manager Beneficiary _-:-__ Other (specify) _ _ _ _ Partner Secretary Agent _ _ Stockholder Treasurer Director Executor/Administrator Receiver