Supporting Documentation · Jan 8, 2025
Exhibit A 2 Filing Application Amendment ECCC 101024
d8cb0f61db5a0087de4c2786b85055e4cfb897da9c8d6326f934a0247d58845bIndexed text · page 8
Show all pagesPage 10A PLEASE TYPE OR PRINT ALL INFORMATION STATE ASSIGNED LICENSE NUMBER __0722._ 33 _ 001 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. seer Het seek Heke: * eek cores JO oe a 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: Russell Guy Last Name a First Name Middle Initial Home Street Address 18 Richwood Place Number 1, Street Name Denville NJ P.O. Box # Municipality State Zip 07834 Social Security Number __154 > 463171 Date of Birth 3 1__2 ;_1954 Home telephone number ( 973 ) 62! - 6368 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) Name of individual (last name first) , stockholder, partner, officer or director: Rotio Christopher Last Name First Name Middle Initial Home Street Address 58 Mackay Ave, Number Thicke Street Name N P.O, Box # Municipality _Waldwie State J Zip 07463. a 78 0561 1 7 1984 Social Security Number 142 - - Date of Birth I / Home telephone number ( 973 )__ 390 - 0600 Area Exchange Number Office telephone number (_973__)_731 -__1400 Area
State J Zip 07463. a 78 0561 1 7 1984 Social Security Number 142 - - Date of Birth I / Home telephone number ( 973 )__ 390 - 0600 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 x Secretary Treasurer Director Trustee Manager Agent Executor/Administrator Receiver Beneficiary Other (specify)
File revisions (1)
- Sep 29, 2026
d8cb0f61db5a5,192,778 bytes