Supporting Documentation · Jan 8, 2025
Exhibit A 2 Filing Application Amendment ECCC 101024
d8cb0f61db5a0087de4c2786b85055e4cfb897da9c8d6326f934a0247d58845bIndexed text · page 9
Show all pagesPage 10A PLEASE TYPE OR PRINT ALL INFORMATION STATE ASSIGNED LICENSE NUMBER 0722.33. O15 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. Jeet seek sete oes HESS II IIIS ISSO ISIS II IIE III ITI I I RII I III II 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: Kelly Joseph Last Name First Name Middle Initial Home Street Address 8 Danbury Ct. 1404 Number Street Name NY P.O. Box#t Municipatty _ Suffern State Zip 10901 aa Saka nah aL 74 8 21 1968 Social Security Number Lat - - goe8 Date of Birth / / Hometelephone number (_973 732 oN i Area Exchange Number Email address: jkelly@essexcountycc.com 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 X. Manager Agent Executor/Administrator Receiver Beneficiary Other (specify) Name of individual Mast iame ish , Stockholder, partner, officer or director: onzalez Willy LastName 5 Westwood Dr. Nditti Name Middle Initial Home Street Address Number Street Name P.O. Box # Municipality West Orange State NJ Zip 07052 21 Social Security Number__148__- +7788 Date of Birth 9 /_ 30 )_1983 Home telephone number (_273 )_ 640 -__
ome Street Address Number Street Name P.O. Box # Municipality West Orange State NJ Zip 07052 21 Social Security Number__148__- +7788 Date of Birth 9 /_ 30 )_1983 Home telephone number (_273 )_ 640 -__ 9642 Area Exchange Number Office telephone number (__973__)__ 734 ____ 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 X Manager Agent Executor/Administrator Receiver Beneficiary Other (specify)
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- Sep 29, 2026
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