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

Page 6 PLEASE TYPE OR PRINT ALL INFORMATION STATE ASSIGNED LICENSE NUMBER _1802_. 33. 005 _ (011 6.1 62 63 64 ALL APPLICANTS ANSWER THE FOLLOWING HAS THE APPLICANT EVER BEEN DENIED A LIQUOR LICENSE IN NEW JERSEY? Yes _v¥__No IF THE ANSWER TO THIS QUESTION IS “YES,” ANSWER THE FOLOWING: Type of License or Permit Denied Retail Wholesale Transportation Warehouse Manufacturer Unit of Government which denied License or Permit: _ N/A Date of Denial (approximate if not known) # / Reason for Denial HAS ANY CORPORATION, PARTNERSHIP OR INDIVIDUAL MENTIONED IN THIS APPLICATION, OTHER THAN THE APPLICANT, BEEN DENIED A LIQUOR LICENSE OR PERMIT? Yes _¥__No IF THE ANSWER IS “YES,” ANSWER THE FOLLOWING: Name of Entity__ N/A Last Name First Name Middle Initial Type of License or Permit Denied: Retail Wholesale Transportation Warehouse Manufacturer Unit of Government which denied License or Permit: Date of Denial (approximate if not known) ! 1 Reason for Denial HAS THE APPLICANT OR ANY OTHER PERSON, CORPORATION OR ENTITY MENTIONED 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 HAD A PENALTY IMPOSED IN LIEU OF SUSPENSION, NOT RENEWED, REVOKED OR CANCELLED WITHIN THE 10 YEARS PRIOR TO THE DATE OF THIS APPLICATION? Yes VY No IF THE ANSWER IS “YES,” PROVIDE DETAILS OF EACH BELOW [Complete a separate Page 6 for each action]: Name of Individual _ N/A Last Name First Name Middle Initial DATE OF ACTION / f DOCKET NO. PENALTY WAS IMPOSED BY: [Indicate whether by Division of ABC or identify Local Issuing Authority] PENALTY CONSISTED OF FINED $ NOT RENEWED. [amount] SUSPENDED REVOKED CANCELLED (number of days) OTHER [explain] 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 LICENSED, EVER BEEN CONVICTED OF A CRIMINAL OFFENSE? Yes _¥_No A. IF THE ANSWER IS “YES,” ANSWER THE FOLLOWING: Name of Individual ___N/A Last Name First Name Middle Initial Date of Birth ! / Conviction Date I / State Court of Jurisdiction Description of offense (specific charge) Disposition (fine, penalty, etc.) Nature of interest in entity to be licensed B. Ifapplicable, provide the date the Director of the N.J. Division of Alcoholic Beverage

of offense (specific charge) Disposition (fine, penalty, etc.) Nature of interest in entity to be licensed B. Ifapplicable, provide the date the Director of the N.J. Division of Alcoholic Beverage Control issued an order approving or disapproving disqualification removal / / (No license may be issued without an order from the Director of the Division of Alcoholic Beverage Control determining no disqualification or removing disqualification.) (See R.S. 33:1-31.2 and NJ.A.C. 13:2-15.) Provide Agency Docket No. :[NN]-