Supporting Documentation · Jan 8, 2025
Exhibit A 1 Amendment application filed 4 10 24
d0597015545aa2f0bd7182b46c36971276e239813d9049ea6efb54ad672f2078Indexed text
Page 7 STATE ASSIGNED LICENSE NUMBER _ 0722 - PLEASE TYPE OR PRINT ALL INFORMATION 33. O15 _ 001 71 ALL APPLICANTS OTHER THAN CLUB LICENSE ANSWER THE FOLLOWING DOES THE APPLICANT, A MEMBER OF THE APPLICANT'S IMMEDIATE FAMILY (SPOUSE, CHILDREN, PARENTS, IN- LAWS OR SIBLINGS) OR ANY PERSON WITH A BENEFICIAL INTEREST IN THE SUBJECT LICENSE OF THIS APPLICATION, HAVE ANY INTEREST IN ANY OTHER NEW JERSEY ALCOHOLIC BEVERAGE LICENSE? Yes x No IF THE ANSWER IS “YES,” COMPLETE THE FOLLOWING BY LISTING THE NEW JERSEY LIQUOR LICENSE TWELVE DIGIT NUMBER(S) AND THE NAME(S) OF THE PERSON(S) OR CORPORATION(S) WHO HOLD(S) SUCH INTEREST. USE ADDITIONAL PAGE(S) 7 AS NEEDED. A. License Number - - . Name (Last Name, First Name, Middle Initial or Corporate Name) Relationship to Applicant B. License Number = 7 Name (Last Name, First Name, Middle Initial or Corporate Name) Relationship to Applicant C. License Number - = % Name (Last Name, First Name, Middle Initial or Corporate Name) Relationship to Applicant 7.2 WOULD ANY PERSON OR CORPORATION NAMED IN THIS APPLICATION FAIL TO QUALIFY FOR OWNERSHIP OF THE LICENSE IF APPLYING AS AN INDIVIDUAL BECAUSE OF AGE, CRIMINAL CONVICTION OR PROHIBITED INTERESTS IN OTHER LICENSES? yes __X No IF THE ANSWER IS “YES,” ANSWER THE FOLLOWING BY INSERTING THE NAME OF THE INDIVIDUAL OR CORPORATION AND, IF AN INDIVIDUAL, THE SOCIAL SECURITY NUMBER AND DATE OF BIRTH. USE ADDITIONAL PAGE(S) 7 AS NEEDED n/a Name (Last Name, First Name, Middle Initial or Corporate Name) Social Security Number . - OR NJ Sales Tax Certificate of Authority No Date of Birth / i
Page 8 PLEASE TYPE OR PRINT ALL INFORMATION STATE ASSIGNED LICENSE NuMBER 0722. 33915 ALL APPLICANTS ANSWER THE FOLLOWING 8.1 DOES THE APPLICANT OR ANYONE MENTIONED IN THIS APPLICATION OWE THE STATE OF NEW JERSEY OR THE UNITED STATES ANY LICENSE FEE, PENALTY, INTEREST OR ALCOHOLIC BEVERAGE TAX WHICH HAS ACCRUED PURSUANT TO THE ALCOHOLIC BEVERAGE TAX LAW, THE ALCOHOLIC BEVERAGE LAW OR ANY OTHER NEW JERSEY OR FEDERAL LAW? Yes No 8.2 HAS THE LICENSE BEEN ISSUED, OR IS IT BEING REQUESTED TO BE ISSUED, FOR A HOTEL/MOTEL AS AN EXCEPTION TQ THE POPULATION RESTRICTION UNDER THE PROVISIONS OF R.S. 33:1-12.207 Yes No IF THE ANSWER IS “YES,” IS IT FOR A HOTEL/MOTEL FACILITY OF 50 OR 100 ROOMS? CHECK ONE: 50 ROOMS 100 ROOMS 8.3 HAS THE LICENSE BEEN ISSUED, OR IS IT BEING REQUESTED TO BE ISSUED, AS AN EXCEPTION TO THE TWO LICENSE LIMITATION LAW (R.S. 33 1-13,82) FOR A HOTEL/MOTEL, RESTAURANT, BOWLING ALLEY OR INTERNATIONAL AIRPORT? Yes No IF THE ANSWER IS “YES,” CHECK ONE OF THE FOLLOWING: HOTEL/MOTEL RESTAURANT BOWLING ALLEY INTERNATIONAL AIRPORT THE FOLLOWING ARE TO BE ANSWERED WHEN APPLICATION IS FOR A LICENSE TRANSFER. n/a 8.4 LICENSE NUMBER SOUGHT TO BE TRANSFERRED - = * 8.5 IF THIS IS AREQUEST FOR A PERSON-TO-PERSON TRANSFER, INSERT NAME(S) OF PERSON (Last Name First), PARTNERSHIP OR CORPORATION CURRENTLY HOLDING THE LICENSE: n/a (Last Name, First Name, Middle Initial or Corporate Name) 8.6 IF THISISA REQUEST FOR A PLACE-TO-PLACE TRANSFER OF A POCKET LICENSE (NO SITED PREMISES), MARK AN X HERE: IF THIS IS AREQUEST FOR A PLACE-TO-PLACE TRANSFER OF A SITED LICENSE, INSERT THE ADDRESS OF THE CURRENT SITE FROM WHICH THE LICENSE IS TO BE TRANSFERRED. n/a Street Address d Number Street Name Municipality New Jersey Zip ee THE FOLLOWING ARE TO BE ANSWERED BY APPLICANTS FOR A NEW LICENSE OR A LICENSE TRANSFER. 8.7 INSERT THE ANTICIPATED DATES WHEN PUBLIC NOTICE OF APPLICATION WILL BE PUBLISHED. PUBLICATION MAY NOT BE SOONER THAN THE DATE OF FILING OF THIS APPLICATION Date of first notice / 1 n/a Date of second notice 8.8 | NAME OF NEWSPAPER TO PUBLISH NOTICE 8.9 THE FOLLOWING ARE TO BE ANSWERED BY CORPORATIONS REPORTING A CHANGE OF CORPORATE STRUCTURE WHEREIN A NEW STOCKHOLDER ACQUIRES MORE THAN 1 PERCENT OF THE STOCK OF THE LICENSED COMPANY (ONE PUBLICATION OF NOTICE REQUIRED). Date of notice / / n/a Name of newspaper publishing notice THE FOLLOWING
IN A NEW STOCKHOLDER ACQUIRES MORE THAN 1 PERCENT OF THE STOCK OF THE LICENSED COMPANY (ONE PUBLICATION OF NOTICE REQUIRED). Date of notice / / n/a Name of newspaper publishing notice THE FOLLOWING QUESTIONS ARE FOR CLUB LICENSE APPLICANTS ONLY: n/a 8.10 HAS THE CLUB BEEN IN ACTIVE OPERATION IN THE STATE OF NEW JERSEY FOR AT LEAST THREE YEARS CONTINUOUSLY IMMEDIATELY PRIOR TO THE SUBMISSION OF ITS APPLICATION FOR A LICENSE? Yes No 8.11 IS THE APPLICANT A CONSTITUENT UNIT, CHARTERED OR OTHERWISE DULY ENFRANCISED CHAPTER OR MEMBER CLUB OF A NATIONAL OR STATE ORDER? Yes No 8.12 HAS THE CLUB HAD EXCLUSIVE POSSESSION AND USE OF CLUB QUARTERS FOR THREE CONTINUOUS YEARS? Yes No 8.13 DOES THE CLUB HAVE AT LEAST 60 VOTING MEMBERS? Yes No
Page 9 STATE ASSIGNED LICENSE NUMBER _9722 . 33 PLEASE TYPE OR PRINT ALL INFORMATION 01S _ 001 9.1 9.2 | 9.3 ALL APPLICANTS ANSWER THE FOLLOWING DOES ANY INDIVIDUAL, PARTNERSHIP, CORPORATION OR ASSOCIATION OTHER THAN THE APPLICANT HAVE AN INTEREST DIRECTLY OR INDIRECTLY IN THE LICENSE APPLIED FOR, OR IS THE STOCK OF ANY STOCKHOLDER HELD IN ESCROW OR PLEDGED IN ANY WAY? Yes No IF THE ANSWER IS “YES,” ANSWER THE FOLLOWING USING A SEPARATE PAGE 9 FOR EACH INDIVIDUAL OR CORPORATION OF INTEREST. ATTACH A SEPARATE PAGE OF EXPLANATION IF MORE SPACE IS NEEDED. Name of Individual (Last Name First) or Corporation n/a (Last Name, First Name, Middle Initial or Corporate Name) Social Security Number a 2 OR NJ Sales Tax Certificate of Authority Number Street Address Number Street Name P.O. Box # Municipality State Zip - Describe Nature of Interest DOES ANY INDIVIDUAL, PARTNERSHIP, CORPORATION OR ASSOCIATION HOLD ANY CHATTEL MORTGAGE OR CONDITIONAL BILL OF SALE OR OTHER SECURITY INTEREST ON ANY FURNITURE, FIXTURES, GOODS OR EQUIPMENT TO BE USED IN CONNECTION WITH THE BUSINESS TO BE OPERATED UNDER THE LICENSE APPLIED FOR? Yes _X_No IF THE ANSWER IS “YES,” ANSWER THE FOLLOWING USING A SEPARATE PAGE 9 FOR EACH INDIVIDUAL OR CORPORATION TO BE REPORTED. ATTACH A SEPARATE PAGE OF EXPLANATION IF MORE SPACE IS NEEDED. Name of Individual (Last Name First) or Corporation n/a (Last Name, First Name, Middle Initial or Corporate Name) Social Security Number - - OR NJ Sales Tax Certificate of Authority Number Street Address Number Street Name P.O. Box # Municipality State Zip : Describe Nature of Interest HAS THE APPLICANT AGREED TO PERMIT ANYONE NOT HAVING AN OWNERSHIP INTEREST IN THE LICENSE TO RECEIVE OR AGREED TO PAY ANYONE (BY WAY OF RENT, SALARY OR OTHERWISE) ALL OR ANY PERCENTAGE OF THE GROSS RECEIPTS OR NET PROFIT OR INCOME DERIVED FROM THE BUSINESS TO BE CONDUCTED UNDER THE LICENSE APPLIED FOR? Yes _X No IF THE ANSWER IS “YES,” ANSWER THE FOLLOWING USING A SEPARATE PAGE 9 FOR EACH INDIVIDUAL OR CORPORATION TO BE REPORTED. ATTACH A SEPARATE PAGE OF EXPLANATION IF MORE SPACE IS NEEDED. Name of Individual (Last Name First) or Corporation n/a Last Name First Name Middle Initial Social Security Number - - OR NJ Sales Tax Certificate of Authority Number Street Address Number Street Name P.O. Box # Municipality State Zip Ss Describe Nature of Interest APPLICANTS
iddle Initial Social Security Number - - OR NJ Sales Tax Certificate of Authority Number Street Address Number Street Name P.O. Box # Municipality State Zip Ss Describe Nature of Interest APPLICANTS THAT ARE SOLE PROPRIETORS OR PARTNERSHIPS GO TO PAGE 10A. CORPORATIONS AND LIMITED LIABILITY COMPANIES COMPLETE PAGE 10.
Page 10 PLEASE TYPE OR PRINT ALL INFORMATION STATE ASSIGNED LICENSE NuMBER 9722. 33. 015-001 QUESTIONS TO BE ANSWERED BY CORPORATIONS AND LIMITED LIABILITY COMPANIES ONLY. ANY CORPORATION OR LIMITED LIABILITY COMPANY THAT IS REPORTED TO HAVE AN INTEREST IN THE BUSINESS TO BE LICENSED, WHETHER THE LICENSEE COMPANY, THE PARENT CORPORATION OF THE LICENSED COMPANY, HOLDING COMPANY OR OTHERWISE AFFILIATED IN THE CORPORATE CHAIN, MUST ANSWER THE FOLLOWING USING A SEPARATE PAGE 10 AND PAGE 10A FOR EACH CORPORATION. ANSWER QUESTIONS ON BOTH PAGE 10 AND PAGE 10A FOR EACH CORPORATION 10.1 Name of corporation Essex County Country Club 10.2. Street address of home office 350 Mt. Pleasant Ave. Numi West Orange ber Street Name Municipality State NJ Zip 07052 - 10.3 NJ Sales Tax Certificate of Authority Number __ 220-895-770/000 10.4 IF CORPORATION ADDRESS IN NUMBER 10.2 ABOVE IS OUT OF STATE, REPORT BELOW THE ADDRESS OF ANY OFFICE LOCATION IN NEW JERSEY. INSERT N/A IF NONE Street Address n/a Number Street Name Municipality New Jersey a as o 10.5 IS THE CORPORATION NOW AN EXISTING, VALID CORPORATION? Yes No 10.6 DATE CHARTERED OR INCORPORATED Sy 3 ,_1887 state NJ 0100063426 10.7 CERTIFICATE OF INCORPORATION NUMBER 10.8 IF NOT INCORPORATED UNDER THE LAWS OF NEW JERSEY, HAS THE CORPORATION RECEIVED AN AUTHORIZATION TO CONDUCT BUSINESS IN NEW JERSEY FROM THE NEW JERSEY OFFICE OF THE SECRETARY OF STATE? __* Yes No n/a 10.9 HAS THE CORPORATION CHARTER EVER BEEN REVOKED BY THE OFFICE OF THE SECRETARY OF STATE IN NEW JERSEY? Yes No IF THE ANSWER IS “YES,” INSERT THE DATE OF REVOCATION, OR IF SUSPENDED, THE BEGINNING AND ENDING DATE OF THE SUSPENSION. Date of revocation / / Beginning date I / Ending date | / 10.10 INSERT THE NAME AND ADDRESS OF THE REGISTERED OR AUTHORIZED AGENT IN NEW JERSEY UPON WHOM SERVICE OF PROCESS IN ANY PROCEEDINGS AGAINST THE APPLICANT, PURSUANT TO THE NEW JERSEY ALCOHOLIC BEVERAGE LAW, THE ALCOHOLIC BEVERAGE TAX LAW OR PROCEEDINGS IN A STATE OR U.S. DISTRICT COURT, MAY BE MADE. Meixner, Molly (Last Name, First Name, Middle Initial or Corporation) 350 Mt. Pleasant Ave. Name Street Address Number Street Name West Orange Municipality New Jersey Zip 07052 - Telephone Number (__973__)_731 -__ 1400 Area Exchange Number 10.11 IF THE LICENSED COMPANY IS OWNED BY OTHER CORPORATION(S) OR IS INA CORPORATE CHAIN, ATTACH A DIAGRAM DEPICTING THE
Jersey Zip 07052 - Telephone Number (__973__)_731 -__ 1400 Area Exchange Number 10.11 IF THE LICENSED COMPANY IS OWNED BY OTHER CORPORATION(S) OR IS INA CORPORATE CHAIN, ATTACH A DIAGRAM DEPICTING THE CORPORATE RELATIONSHIPS AND THE PERCENTAGE OF STOCK INTEREST IN THE COMPANY TO BE LICENSED, OWNED BY OTHER CORPORATIONS OR OTHER NON-CORPORATE ENTITITES (INDIVIDUALS, PARTNERSHIPS, ASSOCIATIONS)
Page 10A PLEASE TYPE OR PRINT ALL INFORMATION STATE ASSIGNED LICENSE NUMBER __0722._33 ke 015 _ 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. ESI III III III III III I I III I III III I ITT I TT II II I IIIS SII II ISI II II ISS SSSI SI SI ISI I ISS ISS ISIS SISSIES IIIS IIS SII IIIS. 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 Trapasso Anthony LastName 169 Rensselaer Rd. First Name Middle Initial Home Street Address Number E rete?" Name P.O. Box # Municipality iabicclalowned state__NJ Rene SRE.) 1769 2 1975 Social Security Number 139 - 60 - Date of Birth / 4 / Home telephone number (_973 _)__ 479 -__ 7363 Area Exchange Number Office telephone number ( ) ‘ ‘Area Exchange Number % of business owned or controlled Number of shares Check position that applies Sole owner Partner Stockholder X President Vice-President Secretary Treasurer Director Trustee Manager Agent Executor/Administrator Receiver Beneficiary Other (specify) Name of individual (ast name first), stockholder, partner, officer or director: ponzilli Jason Last Name First Name Middle Initial Home Street Address 210 Smull Ave. Number Street Name P.O. Box # Municipality North Caldwell state__NJ Zip 07006 > wn gee 6 1977 Social Security Number _ 144 - Ghee 1 eee Date of Birth 8 ! U Home
tial Home Street Address 210 Smull Ave. Number Street Name P.O. Box # Municipality North Caldwell state__NJ Zip 07006 > wn gee 6 1977 Social Security Number _ 144 - Ghee 1 eee Date of Birth 8 ! U Home telephone number (__273_) 418 ._ 3252 Area Exchange Number Office telephone number ( ) - Area Exchange Number % of business owned or controlled Number of shares Check position that applies. Sole owner Partner Stockholder President X Vice-President Secretary Treasurer Director Trustee Manager Agent Executor/Administrator Receiver Beneficiary Other (specify)
Page 10A STATE ASSIGNED LICENSE NUMBER PLEASE TYPE OR PRINT ALL INFORMATION 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. TEI III III III II III II III III I I I III II I III I I ISI II IS ISIS IIS II SIS SSIS II SSS SSIS SOS II SSIS SSS ISSO SI SSSI 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: Russell Guy Last Name A First Name Middle Initial Home Street Address 18 Richwood Place Number «7, Street Name Denville NJ P.O. Box # Municipality State Zip 07834 Social Security Number_154__- 463171 Date of Birth 3 /__- 2 _ 1954 Home telephone number ( 973 62 . 6368 Area Exchange Number Office telephone number ( ) = Area Exchange Number % of business owned or controlled Number of shares Check position that applies: Sole owner Partner Stockholder President Vice-President Secretary x 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 58 Mackay Ave, First Name Middle Initial Home Street Address Y 7 Number ldwick Soa"? a P.O, Box # Municipality _Waldwicl State J Zip 07463 _ OP ee ete rer 78 0561 1 1984 Social Security Number__142 - = Date of Birth I Home telephone number
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- Sep 29, 2026
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