Town CrierWest Orange, New Jersey
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Supporting Documentation · Jan 8, 2025

Exhibit A 1 Amendment application filed 4 10 24

Preserved file SHA-256d0597015545aa2f0bd7182b46c36971276e239813d9049ea6efb54ad672f2078

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Page 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: Alll 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. JESS III III II III III ITI I III III II III IIT OTT I IIIS SIS III I I I III IS SII ISIS IIIS I ISS ISS SSSI SS I ISIS ISIS SSSI SA. 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 # Municipality __ Suffern State Zip 10901 ere Se man Al 74 452: 8 21 1968 Social Security Number ee - - Be Date of Birth df; h Home telephone number (_973__) - jkelly@essexcountycc.com Area Exchange Number Email address: __) és : 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 Treasurer Director Trustee X_ Manager Agent Executor/Administrator Receiver Beneficiary Other (specify) Name of individual esp-naine i , Stockholder, partner, officer or director: onzalez, Willy LastName 5 Westwood Dr. Noitti 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

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Name 5 Westwood Dr. Noitti 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 -_ 9642 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 X_ Manager Agent Executor/Administrator Receiver Beneficiary Other (specify)

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