Supporting Documentation · Jan 8, 2025
Exhibit A 1 Amendment application filed 4 10 24
d0597015545aa2f0bd7182b46c36971276e239813d9049ea6efb54ad672f2078Indexed text
TR#: STATE OF NEW JERSEY DEPARTMENT OF LAW AND PUBLIC SAFETY FEE: DIVISION OF ALCOHOLIC BEVERAGE CONTROL DATE RETAIL LIQUOR LICENSE APPLICATION STATE ASSIGNED LICENSE NUMBER DATE APPLICATION FILED: 0722, «33 015-001 4, A, 2024 [For DIVISION use only ] CODE TYPE OF LICENSE (CHECK ONE) THIS APPLICATION IS FOR: CLASS C LICENSES [R.S. 33:1-12] 31 Club A New License 32 Plenary Retail Consumption Person-to-Person Transfer wiBroad Package Privilege (Including Partnership change, x except Limited Partnership) 33 Plenary Retail Consumption Place-to-Place Transfer 36 Plenary Retail Consumption (including expansion of premises) (Hotel/Motel Exception) Change of Corporate Structure 37 Plenary Retail Consumption —— (theatre Exception) Extension of License (to Executor, —— “Receiver, Administrator, etc.) 35 Seasonal Retail Consumption (November 15 through April 30) Renewal of License 34 Seasonal Retail Consumption Amendment of Application on File (May 1 through November 14) Other 44 Plenary Retail Distribution 43 Limited Retail Distribution OTHER 14 Annual State Permit (R.S. 33:1-42, NJAC 13:2-52) 40 Special Permit for a Golf Facility —— “"(NJAC 13:2-5.3) This Area is Reserved for Municipal Use Municipal Fee $. v/ . Effective Date (As Stated in Resoaion Date of rasolaion unless otherwise established.) State Fee $__AV/# Date Denied / / (As Stated in Resolution) Refund Amount $. Special Conditions Attached: Yes No toni. aon ‘a Ks or Print Name (Last Name, Fir8t Name, Middle Initial) of Municipal Clerk or ABC Secretary , (pA Uy ignatyre of Municipal Cletk or ABC Secretary
Page 2 PLEASE TYPE OR PRINT ALL INFORMATION 001 STATE ASSIGNED LICENSE NUMBER 0722 | 33 - O15 - Application is made on behalf of 5 1 = An Individual 2 = Business Corporation 7 = Limited Liability Company 3 =A Partnership incorporated Club 5 = Incorporated Club 6 = Limited Partnership 21 NAME(S) AS IT DOES OR WILL APPEAR ON THE LICENSE CERTIFICATE (NOT “TRADE” NAME). License may be held by Individual (Last Name, First Name, Middle Initial), Partnership or Corporation. Essex County Country Club (Last Name, First Name, Middle Initial or Corporate Name) 2.2 ACTUAL ADDRESS WHERE THE LICENSE IS TO BE USED (SITED PREMISES): Street Address 350 Mt. Pleasant Ave. Number Street Name West Orange ; 07052 Municipality Zip z A il: Telephone number of business (__973_)__ 731 : 1208 email: Area Exchange Number Jkelly@essexcountycc.com 2.3. |fnolicensed premises exists or if a mailing address is different than the “actual address" given above, provide the mailing addres (insert N/A if not applicable): n/a Street Address Number Street Name P.O, Box # Municipality State Zip Telephone (__ ss) - 2.4 New Jersey Sales Tax Certificate of Authority No. 22 OLN 2.5 TRADE NAME(S) UNDER WHICH BUSINESS IS TO BE CONDUCTED. ALL TRADE NAMES MUST BE LISTED AND REGISTERED WITH THE N.J. SECRETARY OF STATE [if a corporation] OR COUNTY CLERK [if a partnership or sole proprietor] Essex County Country Club 2.6 THE FOLLOWING QUESTIONS ARE TO BE ANSWERED BY ALL APPLICANTS OTHER THAN APPLICANTS FOR A NEW LICENSE: A. IS THE LICENSE ACTIVELY USED AT AN OPERATING PLACE OF BUSINESS? Yes No B. IF NO, GIVE THE DATE THE BUSINESS STOPPED OPERATING (OR THE DATE THE LICENSE WAS ORIGINALLY ISSUED IF NEVER SITED AT AN OPERATING BUSINESS): / / C. IF THE LICENSE IS INACTIVE AND THE APPLICATION IS FOR A TRANSFER, WILL THE LICENSE BE USED AT AN OPERATING PLACE OF BUSINESS AFTER APPROVAL? Yes No 27 THE FOLLOWING QUESTIONS ARE TO BE ANSWERED BY AN APPLICANT FOR A NEW LICENSE: n/a A, WILL THE LICENSE BE USED AT AN OPERATING PLACE OF BUSINESS IMMEDIATELY UPON ISSUANCE? Yes No B. IF NO, PROVIDE ANTICIPATED DATE OF LICENSE ACTIVATION: / /
Page 3 STATE ASSIGNED LICENSE NUMBER _9722 PLEASE TYPE OR PRINT ALL INFORMATION 33 O15 001 The following questions identify information about the licensed premises. This describes the area or place which is to be licensed for the sale, service, consumption, delivery, receipt or storage of alcoholic beverages. If the license is inactive and NOT SITED AT A PLACE OF BUSINESS, answer question 3.1 only, entering N/A for “not applicable.” [If you use N/A as a response to question 3.1, question 2.2 on Page 2 should also be answered N/A.] 3 3 3. 3 3. 3 3. 3. 3 1 2 3 4 a 6 v3 8 © HOW MANY SEPARATE BUILDINGS ARE TO BE INCLUDED UNDER THIS LICENSE? If more than one building is to be included under this license, a separate Page 3 is to be submitted covering each building An up-to-date sketch of the entire licensed premises should be submitted for inclusion in the State ABC license file. BUILDING NO.__1 OF 2__ TO BE LICENSED Clubhouse |S THE ENTIRE BUILDING TO BE LICENSED? Yes__X__ No If the answer to question 3.3 is “No,” specify which floors are to be under license and which ones are not by answering the following questions: Basement _X_Yes ___No Allofit __ Yes _X No 1° floor _X Yes ___No Allofit__X Yes ____No 2" floor _ X ves No allofit __XYes ____No 3° floor Yes No Allofit Yes No Specify each additional floor number to be included under this license: If only part of any floor is to be licensed, attach a more detailed explanation with sketches to clearly delineate licensed areas from unlicensed areas. ARE ANY GROUNDS ADJACENT TO THE BUILDING UNDER LICENSE TO BE INCLUDED AS PART OF THE LICENSED PREMISES? Yes No IS THERE ANY UNLICENSED AREA LOCATED BETWEEN BUILDINGS UNDER THIS LICENSE OR BETWEEN LICENSED ADJACENT GROUNDS? Yes X_ No IF THE ANSWER IS “YES,” ATTACH A SKETCH OF THE LICENSED AND UNLICENSED AREAS SHOWING DIMENSIONS IN FEET. DOES THE APPLICANT OWN THE BUILDING? X_Yes No IF “YES,” IS THERE A MORTGAGE ON THE BUILDING? X Yes No DOES THE APPLICANT LEASE THE BUILDING? Yes No If there is a mortgage on the property, answer question 3.8. If the licensed premise is leased, answer question 3.9. MORTGAGEE (HOLDER OF MORTGAGE): TD Bank Name. FirstName, Middle Initial or Corporate Name) Street Address SS BISaSaht Waly way’ Number Street Name P.O. Box # Municipality __ West Orange State NJ Zip __07052 LANDLORD (HOLDER OF LEASE): ale (Last
. FirstName, Middle Initial or Corporate Name) Street Address SS BISaSaht Waly way’ Number Street Name P.O. Box # Municipality __ West Orange State NJ Zip __07052 LANDLORD (HOLDER OF LEASE): ale (Last Name, First Name, Middle Initial or Corporate Name) Street Address Number Street Name P.O. Box # Municipality State Zip -
Page 3 STATE ASSIGNED LICENSE NUMBER _0722 PLEASE TYPE OR PRINT ALL INFORMATION _ 3 015 001 The following questions identify information about the licensed premises. This describes the area or place which is to be licensed for the sale, service, consumption, delivery, receipt or storage of alcoholic beverages. !f the license is inactive and NOT SITED AT A PLACE OF BUSINESS, answer question 3.1 only, entering N/A for “not applicable.” [If you use N/A as a response to question 3.1, question 2.2 on Page 2 should also be answered N/A|] 3.1 3.2 3.3 34 3.5 3.6 3.7 3.8 3.9 HOW MANY SEPARATE BUILDINGS ARE TO BE INCLUDED UNDER THIS LICENSE? If more than one building is to be included under this license, a separate Page 3 is to be submitted covering each building. An up-to-date sketch of the entire licensed premises should be submitted for inclusion in the State ABC license file. BUILDING NO.___2 OF 2 TO BE LICENSED. IS THE ENTIRE BUILDING TO BE LICENSED? No If the answer to question 3.3 is “No,” specify which floors are to be under license and which ones are not by answering the following questions: Poolhouse Yes Basement ____Yes ___No Allofit____Yes ___No 1" floor ____ Yes ___No Allofit ___ Yes ___No 2” floor ___ Yes No Allofit Yes ___—_—sNo 3" floor Yes No All of it _____ Yes No Specify each additional floor number to be included under this license: If only part of any floor is to be licensed, attach a more detailed explanation with sketches to clearly delineate licensed areas from unlicensed areas. ARE ANY GROUNDS ADJACENT TO THE BUILDING UNDER LICENSE TO BE INCLUDED AS PART OF THE LICENSED PRENISES? Ye es No IS THERE ANY UNLICENSED AREA LOCATED BETWEEN BUILDINGS UNDER THIS LICENSE OR BETWEEN LICENSED ADJACENT GROUNDS? Yes X_ No IF THE ANSWER |S “YES,” ATTACH A SKETCH OF THE LICENSED AND UNLICENSED AREAS SHOWING DIMENSIONS IN FEET. DOES THE APPLICANT OWN THE BUILDING? X Yes No IF “YES,” IS THERE A MORTGAGE ON THE BUILDING? X Yes No DOES THE APPLICANT LEASE THE BUILDING? Yes No If there is a mortgage on the property, answer question 3.8. If the licensed premise is leased, answer question 3.9. MORTGAGEE (HOLDER OF MORTGAGE): TD Bank (Last Name, First Name, Middle Initial or Corporate Name) 425 Pleasant Valley Way Street Name Street Address Number N P.O. Box # Municipality West Orange State J Zip 07052 - LANDLORD (HOLDER OF LEASE)
t Name, First Name, Middle Initial or Corporate Name) 425 Pleasant Valley Way Street Name Street Address Number N P.O. Box # Municipality West Orange State J Zip 07052 - LANDLORD (HOLDER OF LEASE) n/a (Last Name, First Name, Middle Initial or Corporate Name) Street Address Number Street Name P.O. Box # Municipality State Zip :
Page 4 PLEASE TYPE OR PRINT ALL INFORMATION 0722 33 015 001 STATE ASSIGNED LICENSE NUMBER - od - 4.4 42 43 44 45 \S THE NEAREST ENTRANCE OF THE PLACE TO BE LICENSED WITHIN 200 FEET OF THE NEAREST ENTRANCE OF ANY CHURCH OR SCHOOL? Yes No IF THE ANSWER IS “YES,” IS A WAIVER SIGNED BY THE APPROPRIATE OFFICIAL ATTACHED TO THIS. APPLICATION? Yes No DOES THE APPLICANT INTEND TO USE ANY VEHICLES FOR THE TRANSPORT OR DELIVERY OF ALCOHOLIC BEVERAGES? Yes No (A TRANSIT INSIGNIA IS NECESSARY BEFORE ALCOHOLIC BEVERAGES MAY BE TRANSPORTED.) HAS THE APPLICANT FILED AN ANNUAL SPECIAL TAX REGISTRATION AND RETURN FORM (TTB F 5630.5) WITH THE FEDERAL ALCOHOL AND TOBACCO TAX AND TRADE BUREAU? Yes No 6 IF “YES,” DATE FILED Z / / fe WILL ANY BUSINESS OTHER THAN THE SALE OF ALCOHOLIC BEVERAGES BE CONDUCTED ON THE PREMISES TO BE LICENSED? __X_ Yes No IF THE ANSWER IS “YES,” INDICATE THE NATURE OF THE BUSINESS AND WHO WILL CONDUCT IT BY RESPONDING TO THE FOLLOWING QUESTIONS: ___ Restaurant pout Applicant ___ Other ___ Catering ___ Applicant ___ Other __ Hotel/Motel ___ Applicant _____ Other _____ Amusements ___ Applicant ___ Other ___N.J. Lottery ____ Applicant ___ Other ____ Grocery or Delicatessen __ Applicant ___ Other _x Other (specify) golf course x Applicant ____ Other IF SOMEONE OTHER THAN THE APPLICANT WILL OPERATE THE OTHER BUSINESS ON THE LICENSED PREMISES, ANSWER THIS QUESTION. IF THERE IS MORE THAN ONE INDIVIDUAL OR COMPANY, ATTACH A SEPARATE PAGE LISTING THE REQUESTED INFORMATION FOR EACH OPERATOR, Business to be operated Name of company/individual (Last Name, First Name or Corporate Name) Street Address Number Street Name Municipality State Zip - NJ Sales Tax Certificate of Authority No.
Page 5 PLEASE TYPE OR PRINT ALL INFORMATION 0722 «33 015 001 STATE ASSIGNED LICENSE NUMBER - - = 5.1 5.2 5.3 ALL APPLICANTS ANSWER THE FOLLOWING IS THE APPLICANT OR ANY OTHER PERSON MENTIONED IN THIS APPLICATION A POLICE OFFICER OR HOLD ANY POSITION ENTRUSTED WITH THE ENFORCEMENT OF ANY LAWS CONCERNING ALCOHOLIC BEVERAGES IN ANY MANNER WHATSOEVER? Yes __X_No If the answer is “Yes,” complete the following Name of individual me Last Name First Name Middle Initial Title of position held Name of Employing Agency DOES THE APPLICANT OR ANY OTHER PERSON MENTIONED IN THIS APPLICATION, OR ANY PERSON HAVING A BENEFICIAL INTEREST IN THE LICENSED BUSINESS, HOLD OFFICE IN THE UNIT OF GOVERNMENT ISSUING THE LICENSE? Yes No IF THE ANSWER IS “YES,” COMPLETE THE GORENG n/a Name of Individual Last Name First Name Middle Initial Title of Office Municipality DOES THE APPLICANT OR ANY OTHER PERSON MENTIONED IN THIS LICENSE APPLICATION, OR ANYONE WITH A BENEFICIAL INTEREST IN THE LICENSED BUSINESS, DIRECTLY OR INDIRECTLY, HAVE ANY INTEREST IN ANY BREWERY, WINERY, DISTILLERY, RECTIFYING AND BLENDING PLANT, IMPORTER OR WHOLESALE ALCOHOLIC BEVERAGE BUSINESS, AS OWNER, PART OWNER, LANDLORD, TENANT, MORTGAGE HOLDER OR AS A STOCKHOLDER, OFFICER, DIRECTOR, AGENT, EMPLOYEE OR OTHERWISE? IF THE ANSWER IS “YES,” ATTACH AN AFFIDAVIT EXPLAINING THE RELATIONSHIP AND NATURE OF THE INTEREST AND COMPLETE THE FOLLOWING A. New Jersey license number, if applicable - - B. IF THE BUSINESS DOES NOT HOLD A NEW JERSEY LIQUOR LICENSE, ANSWER THE FOLLOWING QUESTIONS: Name of entity conducting business (Corporation, Partnership or Individual) n/a (Last Name, First Name, Middle Initial or Corporate Name) Street Address Number Street Name P.O. Box # Municipality State Zip - Type of Business
Page 6 PLEASE TYPE OR PRINT ALL INFORMATION STATE ASSIGNED LICENSE NUMBER _0722 -_ 33 -_015_- (001 ALL APPLICANTS ANSWER THE FOLLOWING 6.1 HAS THE APPLICANT EVER BEEN DENIED A LIQUOR LICENSE IN NEW JERSEY? Yes X No IF THE ANSWER TO THIS QUESTION IS “YES,” ANSWER THE FOLOWING Type of License or Permit Denied: Retail Wholesale Transportation Warehouse Manufacturer Unit of Government which denied License or Permit: nia Date of Denial (approximate if not known) / I Reason for Denial nia 6.2 HAS ANY CORPORATION, PARTNERSHIP OR INDIVIDUAL MENTIONED IN THIS APPLICATION, OTHER THAN THE APPLICANT, BEEN DENIED A LIQUOR LICENSE OR PERMIT? Yes No IF THE ANSWER IS “YES,” ANSWER THE FOLLOWING: Name of Entity n/a Last Name First Name Middle Initial Type of License or Permit Denied: Retail Wholesale Transportation Warehouse Manufacturer Unit of Government which denied License or Permit: Date of Denial (approximate if not known) / / Reason for Denial 6.3 HAS THE APPLICANT OR ANY OTHER PERSON, CORPORATION OR ENTITY MENTIONED IN THIS LICENSE APPLICATION, OR ANYONE WITH A BENEFICIAL INTEREST IN IT, HAD AN INTEREST IN A NEW JERSEY ALCOHOLIC BEVERAGE LICENSE WHICH WAS SURRENDERED, SUSPENDED OR HAD A PENALTY IMPOSED IN LIEU OF SUSPENSION, NOT RENEWED, REVOKED OR CANCELLED WITHIN THE 10 YEARS PRIOR TO THE DATE OF THIS APPLICATION? Yes x No IF THE ANSWER IS “YES,” PROVIDE DETAILS OF EACH BELOW [Complete a separate Page 6 for each action]: Name of Individual nia Last Name First Name Middle Initial DATE OF ACTION i, i DOCKET NO. PENALTY WAS IMPOSED BY: [Indicate whether by Division of ABC or identify Local Issuing Authority] PENALTY CONSISTED OF: FINED $ NOT RENEWED [amount] SUSPENDED REVOKED CANCELLED (number of days) OTHER [explain] 6.4 HAS THE APPLICANT OR ANY OTHER PERSON OR CORPORATION MENTIONED IN THIS LICENSE APPLICATION, OR ANYONE WITH A BENEFICIAL INTEREST IN THE BUSINESS UNDER LICENSE OR TO BE LICENSED, EVER BEEN CONVICTED OF A CRIMINAL OFFENSE? Yes X No A. IF THE ANSWER IS “YES,” ANSWER THE FOLLOWING Name of Individual n/a Last Name First Name Middle Initial Date of Birth ! / Conviction Date / ! State Court of Jurisdiction Description of offense (specific charge) Disposition (fine, penalty, etc.) Nature of interest in entity to be licensed B. Ifapplicable, provide the date the Director of the N.J. Division of Alcoholic Beverage Control issued an order approving or
tion (fine, penalty, etc.) Nature of interest in entity to be licensed B. Ifapplicable, provide the date the Director of the N.J. Division of Alcoholic Beverage Control issued an order approving or disapproving disqualification removal. / (No license may be issued without an order from the Director of the Division of Alcoholic Beverage Control determining no disqualification or removing disqualification.) (See R.S. 33:1-31.2 and N.J.A.C. 13:2-15.) Provide Agency Docket No. :{NN]-
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- Sep 29, 2026
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