Supporting Documentation · Jan 8, 2025
Exhibit A 2 Filing Application Amendment ECCC 101024
d8cb0f61db5a0087de4c2786b85055e4cfb897da9c8d6326f934a0247d58845bIndexed text · page 12
Show all pagesPLEASE TYPE OR PRINT ALL INFORMATION Page 10A 0722. 33. . O15 _ 001 STATE ASSIGNED LICENSE NUMBER 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. SEES IAI I III II III I TO III FEISS SSSI II II IOI I III IIIS seek seek 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: Rakela Esteban Last Name Fi irst Name Middle Initial Home Street Address _93.1 Washington Stree Number Street Name P.O. Box # Municipality Hoboken State NJ Zip _07030 1977 Social Security Number__476 (04 5071 Date of ith 9 y_}9 Home telephone number (201 _)__238 2375 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 Name of individual (last name first) , stockholder, partner, officer or director: Murzenski Michael LastName 1921 Grand St, PHA First Name Middle Initial Home Street 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
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
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- Sep 29, 2026
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