Supporting Documentation · Jan 8, 2025
Exhibit A 1 Amendment application filed 4 10 24
d0597015545aa2f0bd7182b46c36971276e239813d9049ea6efb54ad672f2078Indexed text · page 18
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. JESSE OS SSSI SII III III III I I I TO I TOI I II III IO I II TT I OT I III III III III SOS III SII ISIS SSIS IIIS III IIS SASSI III ISIS IS ISA. 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: Brown Jeffrey Last Name First Name Middle Initial Home Street Address 3 Olde Woods Lane Number A Livia Name P.O. Box # Municipality __ Woodcliff Lake State NJ Zip 07677. ; 80 5522 4 18 1981 Social Security Number 148 : Date of Birth i / Home telephone number (_ 201) __ 832 _ 1995 Area Exchange Number Email address: 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 Name of individual (last name first) , stockholder, partner, officer or director: Klinger Daniel Last Name First Name Middle Initial Home Street Address 2 Ely Ct. Number Street Name P.O. Box # Municipality Livingston state__NJ RSENS TESTO 58 1967 Social Security Number_219 -__5918 Date
ger Daniel Last Name First Name Middle Initial Home Street Address 2 Ely Ct. Number Street Name P.O. Box # Municipality Livingston state__NJ RSENS TESTO 58 1967 Social Security Number_219 -__5918 Date of girth 10, 25 / Home telephone number (__ 273 _)_ 992 -_4913 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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