Exhibit O1 Response to OPRA 2023 1491_Final_Redacted

Page 10A PLEASE TYPE OR PRINT ALL INFORMATION STATE ASSIGNED LICENSE NUMBERO OD, BA -O1S= “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 general pariner is an individual or a corporation. A list of the names and addresses of all-limited partners-must be submitted as an f 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 Pagé 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 officars and directors and attach a current membership list. FEES TO IIIS IOC III OO IIIT IT II TCI TCI TT III SOP TI ISIS IIT II IIS IIT I TI IA III II ISI IIS IISA ISI I II ISA IA NAME “OF-CORPORATION OR ‘CLUB COVERED BY THIS .PAGE {COMPLETE pay IF-APPLICANT OR STOCKHOLDER ISA GO) eee OR PA| TAR Name of. oo (last name a Saat sane Officer or diréctor. ( wats Wout Last'Namef Home Street Address Municipality Social Secnty Numbe Home ilephone nun 46 Office ileahone numbed = Area -sExchange = Number % of businessowned or. controlled fee Number of shares Sole owner Pattner Stockholder ae : i i ~) Director _. Check position that applies; = President" ~_-— = Vice-President Secretary + ~~ Treasurer Trustee = Manager = Agent = Executor/Administrator. Receiver Beneficiary Other (Specify), Name of individual. (ies fname first), stockholder, partner, officer.or: director. Last:Nam Middle Initial Home Street Address Social Security Number Home telephone number Office telephone number. Area Exchange © Number % of business owned or controlled Number of shares Check position that applies: ~~ ‘Sole ‘owner ___\ Partner “+ Stockholder ee __ President ___ Vice-President. ___ Secretary ___ Treasurer Director Trustee __ Manager Agent ___ Executor/Administrator _ Receiver iciary ____ Other (specify) eer RESPONSE TO OPRA 2023-1491 000017