Supporting Documentation · Dec 11, 2024
Exhibit O1 Response to OPRA 2023 1491_Final_Redacted
14cf858babcc3a546c762418557be659093e882cbd53359e82a10cf0bf95ad36Indexed text
Page 7 PLEASE TYPE OR PRINT ALL INFORMATION STATE ASSIGNED LICENSE NUMBER 0122 3 Ol Se (exe) \ 7A ALL APPLICANTS OTHER THAN CLUB LICENSE ANSWER THE FOLLOWING DOES THE APPLICANT, A MEMBER OF THE APPLICANT'S IMMEDIATE FAMILY (SPOUSE, CHILDREN, PARENTS, IN-LAWS OR SIBLINGS) OR ANY PERSON WITH A BENEFICIAL INTEREST IN THE SUBJECT LICENSE OF THIS APPLICATION, HAVE ANY INTEREST IN ANY OTHER NEW JERSEY ALCOHOLIC BEVERAGE LICENSE? Yes x No IF THE ANSWER IS “YES,” COMPLETE THE FOLLOWING BY LISTING THE NEW JERSEY LIQUOR LICENSE TWELVE DIGIT NUMBER(S) AND THE NAME(S) OF THE PERSON(S) OR CORPORATION(S) WHO HOLD(S) SUCH INTEREST. USE ADDITIONAL PAGE(S) 7 AS NEEDED. A. License Number - =e a Name (Last Name, First Name, Middle Initial or Corporate Name) Relationship to Applicant ie Saeko deine: 1” Sobek tke oot te FRI I III FEAST sk 4k: Se B. License Number - 2 é Name (Last Name, First Name, Middle Initial or Corporate Name) Relationship to Applicant SIE C. License Number - = es Name (Last Name, First Name, Middle Initial or Corporate Name) Relationship to Applicant 7.2 ereeer cores Heike Fa SHI III seek Jo Ik see WOULD ANY PERSON OR CORPORATION NAMED IN THIS APPLICATION FAIL TO QUALIFY FOR OWNERSHIP OF THE LICENSE IF APPLYING AS AN INDIVIDUAL BECAUSE OF AGE, CRIMINAL CONVICTION OR PROHIBITED INTERESTS IN OTHER LICENSES? Yes Ds No IF THE ANSWER |S “YES,” ANSWER THE FOLLOWING BY INSERTING THE NAME OF THE INDIVIDUAL OR CORPORATION AND THE SOCIAL SECURITY NUMBER AND DATE OF BIRTH, IF AN INDIVIDUAL. USE ADDITIONAL PAGE(S) 7 AS NEEDED. Name (Last Name, First Name, Middle Initial or Corporate Name) Social Security Number - = OR NJ Sales Tax Certificate of Authority No. Date of Birth Ul / RESPONSE TO OPRA 2023-1491 000009
Page 8 PLEASE TYPE OR PRINT ALL INFORMATION STATE ASSIGNED LICENSE NuMBERDIAQ, - DD -OIS CO ALL APPLICANTS ANSWER THE FOLLOWING 8.1 DOES THE APPLICANT OR ANYONE MENTIONED IN THIS APPLICATION OWE THE STATE OF NEW JERSEY OR THE UNITED STATES ANY LICENSE FEE, PENALTY, INTEREST OR ALCOHOLIC BEVERAGE TAX WHICH HAS ACCRUED PURSUANT TO THE ALCOHOLIC BEVERAGE TAX LAW, THE ALCOHOLIC BEVERAGE LAW OR ANY OTHER ae JERSEY OR FEDERAL LAW? Yes lo 8.2 HAS THE LICENSE BEEN ISSUED, OR IS IT BEING REQUESTED TO BE ISSUED, FOR A HOTEL/MOTEL AS AN EXCEPTION-{O JHE POPULATION RESTRICTION UNDER THE PROVISIONS OF R.S. 33:1-12.20? Yes No IF THE ANSWER IS “YES,” IS IT FOR A HOTEL/MOTEL FACILITY OF 50 OR 100 ROOMS? CHECK ONE: 50 ROOMS 100 ROOMS 8.3 HAS THE LICENSE BEEN ISSUED, OR |S IT BEING REQUESTED TO BE ISSUED, AS AN EXCEPTION TO THE TWO LICENSE LIMITATION LAW (R.S. 33:1-12.32) FOR A HOTEL/MOTEL, RESTAURANT, BOWLING ALLEY OR INTERNATIONAL AIRPORT? Yes s< No IF THE ANSWER IS “YES,” CHECK ONE OF THE FOLLOWING: HOTEL/MOTEL RESTAURANT BOWLING ALLEY INTERNATIONAL AIRPORT THE FOLLOWING ARE TO BE ANSWERED WHEN APPLICATION IS FOR A LICENSE TRANSFER. 8.4 LICENSE NUMBER SOUGHT TO BE TRANSFERRED - - 4 8.5 IF THISIS A REQUEST FOR A PERSON-TO-PERSON TRANSFER, INSERT NAME(S) OF PERSON (Last Name First), PARTNERSHIP OR CORPORATION CURRENTLY HOLDING THE LICENSE: (Last Name, First Name, Middle Initial or Corporate Name) 8.6 IF THIS IS A REQUEST FOR A PLACE-TO-PLACE TRANSFER OF A POCKET LICENSE (NO SITED PREMISES), MARK AN X HERE: IF THIS IS A REQUEST FORA PLACE-TO-PLACE TRANSFER OF A SITED LICENSE, INSERT THE ADDRESS OF THE CURRENT SITE FROM WHICH THE LICENSE IS TO BE TRANSFERRED. Street Address Number Street Name Municipality New Jersey Zip : THE FOLLOWING ARE TO BE ANSWERED BY APPLICANTS FOR A NEWLICENSE OR A LICENSE TRANSFER. 8.7 INSERT THEANTICIPATED DATES WHEN PUBLIC NOTICE OF APPLICATION WILL BE PUBLISHED. PUBLICATION MAY NOT BE SOONER THAN THE DATE OF FILING OF THIS APPLICATION. Date of first notice f I Date of second notice fh i 8.8 NAME OF NEWSPAPER TO PUBLISH NOTICE 8.9 THE FOLLOWING ARE TO BE ANSWERED BY CORPORATIONS REPORTING A CHANGE OF CORPORATE STRUCTURE WHEREIN A NEW STOCKHOLDER ACQUIRES MORE THAN 1 PERCENT OF THE STOCK OF THE LICENSED COMPANY (ONE PUBLICATION OF NOTICE REQUIRED). Date of notice if Us Name of newspaper publishing notice THE FOLLOWING QUESTIONS
W STOCKHOLDER ACQUIRES MORE THAN 1 PERCENT OF THE STOCK OF THE LICENSED COMPANY (ONE PUBLICATION OF NOTICE REQUIRED). Date of notice if Us Name of newspaper publishing notice THE FOLLOWING QUESTIONS ARE FOR CLUB LICENSE APPLICANTS ONLY: 8.10 HAS THE CLUB BEEN IN ACTIVE OPERATION IN THE STATE OF NEW JERSEY FOR AT LEAST THREE YEARS CONTINUOUSLY IMMEDIATELY PRIOR TO THE SUBMISSION OF ITS APPLICATION FOR A LICENSE? Yes No 8.11 IS THE APPLICANT A CONSTITUENT UNIT, CHARTERED OR OTHERWISE DULY ENFRANCISED CHAPTER OR MEMBER CLUB OF A NATIONAL OR STATE ORDER? Yes No 8.12 HAS THE CLUB HAD EXCLUSIVE POSSESSION AND USE OF CLUB QUARTERS FOR THREE CONTINUOUS YEARS? Yes No. 8.13 DOES THE CLUB HAVE AT LEAST 60 VOTING MEMBERS? Yes No RESPONSE TO OPRA 2023-1491 000010
Page 9 PLEASE TYPE OR PRINT ALL INFORMATION, STATE ASSIGNED LICENSE NUMBERO 1a, - a3 SONS - CoO | 91 9.2 9.3 ALL APPLICANTS ANSWER THE FOLLOWING. DOES ANY INDIVIDUAL, PARTNERSHIP, CORPORATION OR ASSOCIATION OTHER THAN THE APPLICANT HAVE AN INTEREST DIRECTLY OR INDIRECTLY IN THE LICENSE APPLIED FOR OR IS THE STOCK OF ANY STOCKHOLDER HELD IN ESCROW OR PLEDGED IN ANY WAY? Yes ek No IF THE ANSWER IS “YES,” ANSWER THE FOLLOWING USING A SEPARATE PAGE 9 FOR EACH INDIVIDUAL OR CORPORATION OF INTEREST. ATTACH A SEPARATE PAGE OF EXPLANATION IF MORE SPACE IS NEEDED. Name of Individual (Last Name First) or Corporation (Last Name, First Name, Middle Initial or Corporate Name) Social'Security Number = - OR NJ Sales Tax Certificate of Authority Number. Street Address Number Street Name P.O. Box # Municipality State Zip 5 Describe Nature of Interest DOES ANY INDIVIDUAL, PARTNERSHIP, CORPORATION OR ASSOCIATION HOLD ANY CHATTEL MORTGAGE OR CONDITIONAL BILL OF SALE OR OTHER SECURITY INTEREST ON ANY FURNITURE, FIXTURES, GOODS OR EQUIPMENT TO BE USED IN CONNECTION WITH THE BUSINESS TO BE OPERATED UNDER THE LICENSE APPLIED FOR? Yes No IF THE ANSWER IS “YES,” ANSWER THE FOLLOWING USING A SEPARATE PAGE 9 FOR EACH INDIVIDUAL OR CORPORATION TO BE REPORTED. ATTACH A SEPARATE PAGE OF EXPLANATION IF MORE SPACE IS NEEDED. Name of Individual (Last Name First) or Corporation (Last Name, First Name, Middle Initial or Corporate Name) Social Security Number S = OR NJ Sales Tax Certificate of Authority Number Street Address Number Street Name P.O. Box # Municipality State Zip Describe Nature of Interest HAS THE APPLICANT AGREED TO PERMIT ANYONE NOT HAVING AN OWNERSHIP INTEREST IN THE LICENSE TO RECEIVE ORAGREED TO PAY ANYONE (BY WAY OF RENT, SALARY OR OTHERWISE) ALL OR ANY PERCENTAGE OF THE GROSS RECEIPTS OR NET PROFIT OR INCOME DERIVED FROM THE BUSINESS TO BE CONDUCTED UNDER THE LICENSE APPLIED FOR? Yes No IF THE ANSWER IS “YES,” ANSWER THE FOLLOWING USING A SEPARATE PAGE 9 FOR EACH INDIVIDUAL OR CORPORATION TO BE REPORTED. ATTACH A SEPARATE PAGE OF EXPLANATION IF MORE SPACE IS NEEDED. Name of Individual (Last Name First) or Corporation Last Name First Name Middle Initial Social Security Number - > OR NJ Sales Tax Certificate of Authority Number Street Address Number Street Name P.O. Box # Municipality aaah State (Al) SS Describe Nature of Interest APPLICANTS THAT
Social Security Number - > OR NJ Sales Tax Certificate of Authority Number Street Address Number Street Name P.O. Box # Municipality aaah State (Al) SS Describe Nature of Interest APPLICANTS THAT ARE SOLE PROPRIETORS OR PARTNERSHIPS GO TO PAGE 10A. CORPORATIONS AND LIMITED LIABILITY COMPANIES COMPLETE PAGE 10. RESPONSE TO OPRA 2023-1491 000011
Page 10 PLEASE TYPE OR PRINTALL INFORMATION STATE ASSIGNED LICENSE NuMBER OIA - 23 O15 60.1 QUESTIONS TO BE ANSWERED BY CORPORATIONS AND LIMITED LIABILITY COMPANIES ONLY. ANY CORPORATION OR LIMITED LIABILITY COMPANY THAT IS REPORTED TO HAVE AN INTEREST IN THE BUSINESS TO BE LICENSED, WHETHER THE LICENSEE COMPANY, THE PARENT CORPORATION OF THE LICENSED COMPANY, HOLDING COMPANY OR OTHERWISE AFFILIATED IN THE CORPORATE CHAIN, MUST ANSWER THE FOLLOWING USING A SEPARATE PAGE 10 AND PAGE 10A FOR EACH CORPORATION. ANSWER QUESTIONS ON BOTH PAGE 10 AND PAGE 10A FOR EACH Mor CLD 10.1. Name of corporation Cesex Comms 7 fp on 10.2 Street address of home office 3 SD M+ D\eas ant & v oe ‘ ose Street Name Municipality Wus OLA State Zip D1O0S2- _ 10.4 IF CORPORATION ADDRESS IN NUMBER 10.2 ABOVE IS OUT OF STATE, REPORT BELOW THE ADDRESS OF ANY OFFICE LOCATION IN NEW JERSEY. INSERT N/A IF NONE. Street Address Number Street Name Municipality New Jersey. Zip = 10.5 IS THE CORPORATION NOW AN EXISTING, VALID CORPORATION? X Yes No 10.6 DATE CHARTERED OR INCORPORATED iS) U 2 = ! ) ao) STATE ot 107 CERTIFICATE OF INCORPORATION NuMBER _O|OOOW SY 2. 10.8 IF NOT INCORPORATED UNDER THE LAWS OF NEW JERSEY, HAS THE CORPORATION RECEIVED AN AUTHORIZATION TO CONDUCT BUSINESS IN NEW JERSEY FROM THE NEW JERSEY OFFICE OF THE SECRETARY OF STATE? Yes No 10.9 HAS THE CORPORATION CHARTER EVER BEEN REVOKED BY THE OFFICE OF THE SECRETARY OF STATE IN NEW JERSEY? Yes No IF THE ANSWER IS “YES,” INSERT THE DATE OF REVOCATION, OR IF SUSPENDED, THE BEGINNING AND ENDING DATE OF THE SUSPENSION. Date of revocation / 1 Beginning date U / Ending date 7 / 10.10 INSERT THE NAME AND ADDRESS OF THE REGISTERED OR AUTHORIZED AGENT IN NEW JERSEY UPON WHOM SERVICE OF PROCESS IN ANY PROCEEDINGS AGAINST THE APPLICANT, PURSUANT TO THE NEW JERSEY ALCOHOLIC BEVERAGE LAW, THE ALCOHOLIC BEVERAGE TAX LAW OR PROCEEDINGS IN A STATE OR U.S. DISTRICT COURT, MAY BE MADE. Name __ SU | Wan, Chet dinw Street Address Municipality’ New Jerse Telephone Number 10.11 IF THE LICENSED COMPANY IS OWNED BY OTHER CORPORATION(S) OR IS INA CORPORATE CHAIN, ATTACHA DIAGRAM DEPICTING THE CORPORATE RELATIONSHIPS AND THE PERCENTAGE OF STOCK INTEREST IN THE COMPANY TO BE LICENSED, OWNED BY OTHER CORPORATIONS OR OTHER NON-CORPORATE ENTITITES (INDIVIDUALS, PARTNERSHIPS, ASSOCIATIONS). RESPONSE TO OPRA 2023-1491 000012
Page 108 PLEASE TYPE OR PRINT ALL INFORMATION STATE ASSIGNED LICENSE NUMBERO IA - AS _. O15. CO| 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 eral partner Is an individual or a corporation. A list of the names and addresses of all limited partners must be submitted as an tachment 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 CORPORATIONS: All corporation applicants or licensees and any corporation that has an ownership interest in the corporation under license or to be licensed must have been reported on Page 10, Information on this Page, 10A, will identify all officers, directors and stockholders holding one percent or more of the shares of the respective company. Club licenses must list names of officers and directors and attach a current membership list. FHSAA IT IIIT IT IAI IT TIT IO TOI TIT TI IIIT IT ITI IIT SI IIT TS ASOT I SIA IAAI I OSS AIDS I III II IIIA I NAME OF CORPORATION OR CLUB COVERED BY THIS PAGE (COMPLETE ONLY IF APPLICANT OR STOCKHOLDER |S A ORRIN OR i Una a ON Ly & | a0) OvUn Name of individual (last name first), Rta partner, officer or director: Ost yt SAmaeS Last Nam M Initial Home Street Address Social Security Number Date of Birth Office telephone number Area Exchange Number % of business owned or controlled Number of shares Check positiop that applies: ‘Sole owner Partner Stockholder we President Vice-President Secretary Treasurer —____ Director Trustee Manager Agent Executor/Administrator __ Receiver Beneficiary Other (specify) eoernee (last name first) , (ie partner, 0 ror director: Fie | tS <4 Last Name Home Street Address Middle Initial © P.O. Box # State | Security Number Home telephone numbe| Office telephone numbei % of business owned or controlled Number of shares Check position that applies: Sole owner Partner Stockholder President Wice-President Secretary Treasurer __ Director Trustee Manager Agent Executor/Administrator _~___ Receiver Beneficiary Other (specify) RESPONSE TO OPRA 2023-1491 000013
Page 10A PLEASE TYPE OR PRINT ALL INFORMATION STATE ASSIGNED LICENSE NUMBEROIDD, 23 _C1S-_CO| ALL APPLICANTS ANSWER THE FOLLOWING [ADD PAGES AS NECESSARY] SOLE OWNERS AND PARTNERSHIPS: Complete this page jn full. LIMITED PARTNERSHIPS: All information about a general partner or partners of a limited partnership must be reported, whether the néral partner is an individual or a corporation, A list of the names and addresses of all limited partners must be submitted as an attachment 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, CORPORATIONS: All corporation applicants or licensees and any corporation that has an ownership interest in the corporation \under license or to be licensed must have been ‘reported on ‘Page 10. Information on ‘this Page, 10A, will identify all officers, directors and stockholders holding one percent or more of the shares of the respective company. ‘Club licenses mustlist names Of officers ‘and directors and attach a current membership list. SETS ISSO IO SOE II III IIIS IIIS IIIS ETAT EI III III ITI IIIT II IIIT IIS IIIA IIIT ACACIA AT AT IT IIA A SI III NAME OF CORPORATION OR ‘CLUB:COVERED BY THIS PAGE (COMPLETE ONLY IF APPLICANT. OR STOCKHOLDER ISA: ESTOS OR Pree on EG | ce) pa ee dividual (last name first), Stockholder, r, Officer or director; OF Middle'Initial” Number) Municipality] e telephone number vAreases=-) sExchange==-s-Number == % of business owned or controlled Number of shares Check position that applies: Sole owner. Partner. Stockholder : acinar ie President Vice-President ~~ Secretary Treasurer = -= = Director. Trustee _ Manager _ Agent ——_Executor/Administrator ~~ <= Receiver Beneficiary Other (specify) t Name of individual (last name first) , stockholder, partner, officer or director: zs 3 « i Span ess i OSPEGL Ine eee : Last Name Home Street Address P Zip Social.Security Number Home telephone number Office telephone number ( ‘Area Exchange Number % of business owned or controlled Number of shares ae Check position that applies: Sole owner Partner Stockholder President _ Vice-President De ceen Treasurer Director Trus Agent Executor/Administrator Receiver RESPONSE TO OPRA 2023-1491 000014
; Page 10A PLEASE TYPE OR PRINT ALL INFORMATION TE ASSIGNED LICENSE numeer© 190, 2B" OlS=. CCl 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 ofall limited partners must be submitted as an attachment to this application with an identification of the percentage of each limited partner as it relates to total ownership of the business entity fo 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 must have been reported on Page 10. Information on this Page, 410A, will identify all officers, “directors and stockholders holding one percent ormore of the shares of the respective company. Club licenses must list names of: Rules and directors and attach a current membership list. JEDI SISSIES IIIS ICT II I IIIT IIE IAI ITO TTI IIIS TT IT A TIT OA IT TASS I IIIA NAME OF CORPORATION OR CLUB ‘COVERED BY THIS PAGE (COMPLETE ONLY IF APPLICANT OR STOCKHOLDER IS A ee oe OR SERS Ss (GOR iy G | — b is ‘of individual (last ‘name first),'Stockhol es ner, ee director. Caw i LastName Home Street Address Number. SP.OsBox# Municipality *Social Security Number. Home telephone number (Office telephone number. % Of business owned or controlled = Numberof shares é Check position that applies; — = Sole owner __= = Partner. _ =~ Stockholder Aes el President Vice-President Secretary. Treasurer : Vee Trustee ___~. Manager Agent: ———_ Executor/Administrator. == Receiver Beneficiary Other (specify) i Ci of individual (last name first) , stockholder, ae officer or.director: > zs = ASC and Pai p aie ies. Last Name Middle Initial Home Street Address = pe. Number P.O. Box # Municipality Zi Social Security Number] Home telephone numb Office telephone numbel rea % of business owned or controlled <i Number of shares ee Check position that applies: Sole owner Partner Stockholder we sident Vice-President Secretary Treasurer rector nager Agent Executor/Administrator Receiver Other (specify) RESPONSE TO OPRA 2023-1491 000015
Page 10A PLEASE Bi OR PRINT ALL INFORMATION STATE ASSIGNED LICENSE numseROIGD, BS 0157 CO ALL APPLICANTS ANSWER THE FOLLOWING [ADD PAGES AS NECESSARY] SOLE OWNERS AND PARTNERSHIPS: Compiete 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 pariners must be submitted as an attachment 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. CORPORATIONS: All corporation applicants or licensees and any corporation that has an ownership interest in the corporation under license ‘or to-be licensed must have been reported-on Page 10. “Information on this Page, 410A, will identify all officers, directors and stockholders holding one percent ormore of the shares of the'respective company. Club licenses must listnames Of officers and directors ‘and attach a current membership list. ERED S OSS O OSHS SO IIS ISO OIISIEOHE IIIT IDO EI IOS IA IS TIO ISI III I TIARA I III III III I III II III ISIS I SASSI AA. NAME OF CORPORATION ‘OR CLUB COVERED BY THIS PAGE (COMPLETE ONLY IF ABELICANY OR STOCKHOLDER 1S A ere) eee OR PARYNERSHIP: 4 a PINERSHE) Ones. SO.) massa idual (lastname a eon r, partner, ‘officer or‘director: : : MiMwin Ss oe ON : ASER RS E Home Street Address ae i Number P;O: Box# Municipality 4 == Social Security Numbe Home telephone numbe| Office telephone numbeg I é Area: Exchange: be ehoniber, $ % Of business owned or f controlled i Number of shares Check position that applies: Sole owner 4 Partner == Stockholder =: Soa re a President. Vice-President. Secretary Treasurer Director Trustee. Manager “= “Agent = Executor/Administrator _ __ Receiver Beneficiary Other (specify). Name of individual (last name first) stockholder, partner, officer.or director. Last Nam Home Street Address lumber: Municipality Social Security Number Home telephone number Office telephone number Area Exchange Number %, of business owned or controlled Number of shares — é Nears Check position that applies: ~~ Sole owner —— Partner ~~ Stockholder wees President Vice-President Secretary ____ Treasurer Director _“Trustee. - ____ Manager ____ Agent ___ Executor/Administrator _
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