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: 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. FEISS II III OI III III III III III I I I I II I II I I IIT OS IOI IIIS OD I IIIS SSIS ISI ISI II I AS SIS IIS SISOS OS I II SSI ISSA 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: Purcell atric Last Name z «a First Name Middle Initial Home Street Address 131 Marion Drive Number Street Name P.O. Box # Municipality _ West Orange State NJ Zip 07052 - 29 Social Security Number _146 ees -_ 9721 Date of Birth__12 / )_1966 Home telephone number (__973 _) 204 2, 1498 Area Exchange Number Office telephone number ( ) E 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 Bariliclary X other (epacity) Member, Board of Governors Name of individual (last name first) , stockholder, partner, officer or director: Lavoie Justin Force anda cee 14 Meadow Lane First Name Middle Initial Number a Street Name NI P.O. Box # Municipality cone) State Zip 07044 Social Security Number_920 52 -__ 7568 Date of Birth «© s_'12 joists Hemetelephoné number

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14 Meadow Lane First Name Middle Initial Number a Street Name NI P.O. Box # Municipality cone) State Zip 07044 Social Security Number_920 52 -__ 7568 Date of Birth «© s_'12 joists Hemetelephoné number (923° 5.27 -_9397 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 X other (specify) _ Member, Board of Governors

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