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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: 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. JORIS EIS III III III I TORII III TI TI I II I I III IIIS III IS SSSI SSSI SSSI ISIS IIIT OD IIIS I IIS SSSI IS ISS SII SI SSSI SSSI SSS ISIS S 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: Penaherrera David ae jkast ame 18 Pearl Street First Name Middle Initial Number Street Name P.O. Box # Municipality _ Passaic state NJ. Zip 07055 - Sotial Seourity Number Sho. 99> 2 8881 Date of Birth 5 ;__16 jo doe Home telephone number (__201 __) 702 4156 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 ____ Treasurer ___ Director Trustee __**_ Manager ____ Agent ___Executor/Administrator __ Receiver _____ Beneficiary ____ Other (specify) Name of individual (last name first) , stockholder, partner, officer or director: Gonzales Leandro ee sash Name 104 Davis Ave. First Name Middle Initial Number ___ Street Name P.O. Box # fMuniefgaity:_ =eartison State Ny Zip 07029 _- Social Security Number_150. «19 =~ —8637 Date of Birth _ 10 ;_18

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ee sash Name 104 Davis Ave. First Name Middle Initial Number ___ Street Name P.O. Box # fMuniefgaity:_ =eartison State Ny Zip 07029 _- Social Security Number_150. «19 =~ —8637 Date of Birth _ 10 ;_18 ;__1996 Home telephone number (___ 201) 519 - 4490 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 ___ Treasurer ____ Director ____Trustee __X_Manager ____ Agent ____ Executor/Administrator ___ Receiver Beneficiary Other (specify)

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