Supporting Documentation · Jan 8, 2025
Exhibit A 1 Amendment application filed 4 10 24
d0597015545aa2f0bd7182b46c36971276e239813d9049ea6efb54ad672f2078Indexed text · page 17
Show all pagesPage 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. JESS IIIA I IOI II IOI TI II IIIT IS I IIIT III III I II I TI SI TT II II III IIS SSSI SSS SSIS ISS ISSIS SSIS SSS IIIS SIAN. 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: Rakela Esteban Last Name ‘ irst Name Middle Initial Home Street Address 931 ‘Washington Stree! Number Street Name P.O. Box # Municipality Hoboken State NJ Zip 07030 - 1977 Social Security Number__476 ‘04 -_ 5071 Date ofith 9 oy 19 Home telephone number (_ 201 ) 238 a 2375 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) Member, Board of Governors Name of individual (last name first) , stockholder, partner, officer or director: Murzenski Michael LastName 102] Grand St, PHA First Name Middle Initial Home Street Address Number Hobok. Street Name P.O. Box # Municipality siecsiabd state_NJ Zip 07030 ss 1969 Social Security Number _141. -_ 66 -__ 6182 Date of Birth? / / Home
First Name Middle Initial Home Street Address Number Hobok. Street Name P.O. Box # Municipality siecsiabd state_NJ Zip 07030 ss 1969 Social Security Number _141. -_ 66 -__ 6182 Date of Birth? / / Home telephone number (_291 )__ 424 -__ 3154 Area Exchange Number Office telephone number ( ) 2 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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- Sep 29, 2026
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