Supporting Documentation · Jan 8, 2025
Exhibit A 1 Amendment application filed 4 10 24
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Show all pagesPage 2 PLEASE TYPE OR PRINT ALL INFORMATION 001 STATE ASSIGNED LICENSE NUMBER 0722 | 33 - O15 - Application is made on behalf of 5 1 = An Individual 2 = Business Corporation 7 = Limited Liability Company 3 =A Partnership incorporated Club 5 = Incorporated Club 6 = Limited Partnership 21 NAME(S) AS IT DOES OR WILL APPEAR ON THE LICENSE CERTIFICATE (NOT “TRADE” NAME). License may be held by Individual (Last Name, First Name, Middle Initial), Partnership or Corporation. Essex County Country Club (Last Name, First Name, Middle Initial or Corporate Name) 2.2 ACTUAL ADDRESS WHERE THE LICENSE IS TO BE USED (SITED PREMISES): Street Address 350 Mt. Pleasant Ave. Number Street Name West Orange ; 07052 Municipality Zip z A il: Telephone number of business (__973_)__ 731 : 1208 email: Area Exchange Number Jkelly@essexcountycc.com 2.3. |fnolicensed premises exists or if a mailing address is different than the “actual address" given above, provide the mailing addres (insert N/A if not applicable): n/a Street Address Number Street Name P.O, Box # Municipality State Zip Telephone (__ ss) - 2.4 New Jersey Sales Tax Certificate of Authority No. 22 OLN 2.5 TRADE NAME(S) UNDER WHICH BUSINESS IS TO BE CONDUCTED. ALL TRADE NAMES MUST BE LISTED AND REGISTERED WITH THE N.J. SECRETARY OF STATE [if a corporation] OR COUNTY CLERK [if a partnership or sole proprietor] Essex County Country Club 2.6 THE FOLLOWING QUESTIONS ARE TO BE ANSWERED BY ALL APPLICANTS OTHER THAN APPLICANTS FOR A NEW LICENSE: A. IS THE LICENSE ACTIVELY USED AT AN OPERATING PLACE OF BUSINESS? Yes No B. IF NO, GIVE THE DATE THE BUSINESS STOPPED OPERATING (OR THE DATE THE LICENSE WAS ORIGINALLY ISSUED IF NEVER SITED AT AN OPERATING BUSINESS): / / C. IF THE LICENSE IS INACTIVE AND THE APPLICATION IS FOR A TRANSFER, WILL THE LICENSE BE USED AT AN OPERATING PLACE OF BUSINESS AFTER APPROVAL? Yes No 27 THE FOLLOWING QUESTIONS ARE TO BE ANSWERED BY AN APPLICANT FOR A NEW LICENSE: n/a A, WILL THE LICENSE BE USED AT AN OPERATING PLACE OF BUSINESS IMMEDIATELY UPON ISSUANCE? Yes No B. IF NO, PROVIDE ANTICIPATED DATE OF LICENSE ACTIVATION: / /
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- Sep 29, 2026
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