Supporting Documentation · Jan 8, 2025
Exhibit A 2 Filing Application Amendment ECCC 101024
d8cb0f61db5a0087de4c2786b85055e4cfb897da9c8d6326f934a0247d58845bIndexed text
reet Address 2 Number Hobok Street Name P.O. Box# Municipality ppeken tate NJ Zip _ 07030 1969 Social Security Number _ 141 29288 6182 Date of Birth? I Home telephone number (_201 )__ 424 -__3154 Area Exchange Number Office telephone number (_973___)_731 1400 Area Exchange Number % of business owned or controlled Number of shares Check position that applies: Sole owner Partner Stockholder President Vice-President Secretary Treasurer Director Trustee Manager Agent Executor/Administrator Receiver Beneficiary x Other (specify) Member, Board of Governors
Page 10A PLEASE TYPE OR PRINT ALL INFORMATION STATE ASSIGNED LICENSE NUMBER 001 0722. 33 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 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 must list names of officers and directors and attach a current membership list FI III II III IIIS III IS OSI III I III TI III IIIS IT OS OS OI III SI SII SOD I IIIS AI ISOS III IS I SSS SSIS OSI ISIS SOS I NAME OF CORPORATION OR CLUB COVERED BY THIS PAGE (COMPLETE ONLY IF APPLICANT OR STOCKHOLDER IS A CORPORATION OR PARTNERSHIP): Essex County Country Club Name of individual (last name first), stockholder, partner, officer or director: Brown Jeffrey Last Name First Name Middle Initial Home Street Address 3 Olde Woods. Lane Number ia Name P.O. Box # Municipatity___ Woodcliff Lake State NJ Zip __07677__- 1 80 5522 4 18 981 Social Security Number__148 5 Date of Birth / Home telephone number (__ 201 i} 832 -_1995 Area Exchange Number Email address: Office telephone number (__973 L273 . 1400 Area Exchange Number % of business owned or controlled Number of shares Check position that applies: Sole owner Partner Stockholder President Vice-President Secretary Treasurer Director Trustee Manager Agent Executor/Administrator Receiver Beneficiary __X_ Other (specify) Member, Board of Governors Name of individual (last name first) , stockholder, partner, officer or director: Klinger Daniel Last Name First Name Middle Initial Home Street Address 2 Ely Ct. Number Street Name P.O. Box # Municipality __Livingston state__NJ 2p ____-______ 58 1967 Social Security Number _219 : -__ 5918 Date of
ast Name First Name Middle Initial Home Street Address 2 Ely Ct. Number Street Name P.O. Box # Municipality __Livingston state__NJ 2p ____-______ 58 1967 Social Security Number _219 : -__ 5918 Date of ith 10, 25 Home telephone number (__973__)_ 992 - 4913 Area Exchange Number Office telephone number (_ 973) _731 -_1400 Area Exchange Number % of business owned or controlled Number of shares Check position that applies: Sole owner Partner Stockholder President Vice-President Secretary Treasurer Director Trustee Manager Agent Executor/Administrator Receiver Beneficiary Other (specify) Member, Board of Governors
Page 10A PLEASE TYPE OR PRINT ALL INFORMATION STATE ASSIGNED LICENSE NUMBER __0722._33 Le. 901 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 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 must list names of officers and directors and attach a current membership list. FEISS III III III III II I II III III see sete Hote NAME OF CORPORATION OR CLUB COVERED BY THIS PAGE (COMPLETE ONLY IF APPLICANT OR STOCKHOLDER IS A CORPORATION OR PARTNERSHIP): Essex County Country Club Name of individual (last name first), stockholder, partner, offiger or director: irscl ason Last Name inst Name Middle Initial Home Street Address 3222 Runnymede RE Number Street Name P.O. Box # Municipality Essex Fells State NJ Zip 07021 _- ee a 8 1974 Social Security Number 150-72 7097 Date of Birth 973 ea S186 Home telephone number ( ) - Area Exchange Number Office telephone number (_973___) _731 -_ 1400 Area Exchange Number % of business owned or controlled Number of shares Check position that applies: Sole owner Partner Stockholder President Vice-President Secretary Treasurer Director Trustee Manager Agent Executor/Administrator Receiver Beneficiary __* Other (specify) ___ Member, Board of Governors Name of individual (last name first) , stockholder, partner, officer or director: eglio Steven Last Name First Name Middle Initial Home Street Address 60 Roseland Ave. Number Street Name P.O. Box # Municipality Caldwell state__NJ Zip . 1 26 1961 Social Security Number 136 38 - olss Date of Birth / / Home telephone number (__973 _)__ 226 ___ $300 ‘Area Exchange Number Office telephone
P.O. Box # Municipality Caldwell state__NJ Zip . 1 26 1961 Social Security Number 136 38 - olss Date of Birth / / Home telephone number (__973 _)__ 226 ___ $300 ‘Area Exchange Number Office telephone number (__973 731 -__ 1400 Area Exchange Number % of business owned or controlled Number of shares Check position that applies: Sole owner Partner Stockholder President Vice-President Secretary Treasurer Director Trustee Manager Agent Executor/Administrator Receiver Member, Board of Governors Beneficiary Other (specify)
Page 11 PLEASE TYPE OR PRINT ALL INFORMATION STATE ASSIGNED LICENSE NUMBER 0722.33. 015-001 AFFIDAVIT LICENSE PERIOD APPLIED FOR From _2024 to _2025 DATE State of New Jersey ; ) ss County of _ Essex ) ) As provided by law (R.S. 33:1-35), (Check One) 1. The Individual Applicant 2, Members of the Partnership Applicant 3 Joseph Kelly, Manager of Essex County Country Club (President/Vice-President) (Corporation or Club Name) consent(s) that the licensed premises and all portions of the building constituting the licensed premises, including all rooms, cellars, closets, out-buildings, passageways, vaults, yards, attics and every part of the structure of which the licensed premises are a part and all buildings used in connection therewith which are in his/her/their possession or under his/her/their control, may be inspected and searched without warrant at all hours by the Director of the Division of Alcoholic Beverage Control, his or her duly authorized deputies, inspectors or investigators and all other sworn law enforcement officers, and being duly sworn according to law, upon his/her/their oath(s), depose(s) and say(s) that he/she is (they are) the person(s) duly authorized to sign the application, that in instance of corporate ownership, the signator is authorized by corporate resolution to sign on behalf of the corporations: and that the contents of this application represent complete disclosure of the fact, and that the contents of this application are true. (Signature of Individual Agent / Sole Proprietor) (Corporations Only) Attestation by Corporate Secretary (Parinership Name) (Signature of Partner) Essex County County Club Attest Corporate V7) (Signature of Partner) \ By { Secretary (Signaturg 3 Corporate Rresident or Vice President) (Signature of Partner) Signature By: Jos¢ph Kelly Affix Corporate Seal Title: Manager (Signature of Partner) Sworn to and subscribed before me this Lr day of ty KY (Signature of Officer Administering Gt, B. Saccomanno Notary Public of New Jersey ‘oinmission Expires May 19, 2027 AFFIDAVIT MUST BE SIGNED HERE ---- BY DULY AUTHORIZED : NOTARY PUBLIC (Printed Name of Officer Administering Oath) My C OR AN ATTORNEY-AT-LAW iy OF NEW JERSEY (tle of Officer Administering Oath) (Cate of Expiration of Commission, if applicable)
ESSEX COUNTY COUNTRY CLUB- GOLF COURSE
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ORIGIN ID:MMUA. (973) 530-2432 SHIP DATE: 100CT24 LISA BARATA ACTWGT: 0.50 LB CHIESA SHAHINIAN & GIANTOMASI PC. CAD: 261719439/FAPI2208 105 EISENHOWER PKWY DIMS: 13x10x1 IN ROSELAND, NJ 07068 BILL SENDER UNITED STATES US To KAREN CARNEVALE-MUNICIPAL CLERK TOWNSHIP OF WEST ORANGE 66 MAIN ST S8CI2IB264/C6C4 WEST ORANGE NJ 07052 (@73) 530-2462 REF: 32540,0002 DEPT: PO: AU RUEVOY A000 A ‘a eesnartsoi 8 al FRI - 11 OCT 10:30A 7794 6740 0349 PRIORITY OVERNIGHT 07052 E2 MMUA xo-vs EWR IN
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- Sep 29, 2026
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