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

Page 4 PLEASE TYPE OR PRINT ALL INFORMATION STATE ASSIGNED LICENSE NUMBER _1802_- 33. 005-011 41 4.2 4.3 44 ‘d ¥ 45 IS THE NEAREST ENTRANCE OF THE PLACE TO BE LICENSED WITHIN 200 FEET OF THE NEAREST ENTRANCE OF ANY CHURCH OR SCHOOL? Yes _v_No IF THE ANSWER IS “YES,” IS A WAIVER SIGNED BY THE APPROPRIATE OFFICIAL ATTACHED TO THIS APPLICATION? Yes No DOES THE APPLICANT INTEND TO USE ANY VEHICLES FOR THE TRANSPORT OR DELIVERY OF ALCOHOLIC BEVERAGES? Yes _v¥__No (A TRANSIT INSIGNIA IS NECESSARY BEFORE ALCOHOLIC BEVERAGES MAY BE TRANSPORTED.) HAS THE APPLICANT FILED AN ANNUAL SPECIAL TAX REGISTRATION AND RETURN FORM (TTB F 5630.5) WITH THE FEDERAL ALCOHOL AND TOBACCO TAX AND TRADE BUREAU? Yes _v¥__No (Tobe filed upon license transfer approval) IF “YES,” DATE FILED ! / WILL ANY BUSINESS OTHER THAN THE SALE OF ALCOHOLIC BEVERAGES BE CONDUCTED ON THE PREMISES TO BE LICENSED? _v¥__ Yes No IF THE ANSWER |S “YES,” INDICATE THE NATURE OF THE BUSINESS AND WHO WILL CONDUCT IT BY RESPONDING TO THE FOLLOWING QUESTIONS: _v__ Restaurant _v¥__ Applicant ___ Other _¥_ Catering _¥__ Applicant _____ Other ____ Hotel/Motel ____ Applicant _____ Other ____ Amusements ____ Applicant ___ Other ___NJ. Lottery _—__ Applicant ___ Other ___ Grocery or Delicatessen ____ Applicant ___ Other _vY___ Other (specify) Golf and Pool _v Applicant _____ Other IF SOMEONE OTHER THAN THE APPLICANT WILL OPERATE THE OTHER BUSINESS ON THE LICENSED PREMISES, ANSWER THIS QUESTION. IF THERE IS MORE THAN ONE INDIVIDUAL OR COMPANY, ATTACH A SEPARATE PAGE LISTING THE REQUESTED INFORMATION FOR EACH OPERATOR. Business to be operated NA Name of company/individual (Last Name, First Name or Corporate Name) Street Address Number Street Name Municipality State Zip - NJ Sales Tax Certificate of Authority No.