Supporting Documentation · Jan 8, 2025
Exhibit A 2 Filing Application Amendment ECCC 101024
d8cb0f61db5a0087de4c2786b85055e4cfb897da9c8d6326f934a0247d58845bIndexed text · page 13
Show all pagesPage 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
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