Supporting Documentation · Jan 8, 2025
Exhibit A 1 Amendment application filed 4 10 24
d0597015545aa2f0bd7182b46c36971276e239813d9049ea6efb54ad672f2078Indexed text · page 8
Show all pagesPage 7 STATE ASSIGNED LICENSE NUMBER _ 0722 - PLEASE TYPE OR PRINT ALL INFORMATION 33. O15 _ 001 71 ALL APPLICANTS OTHER THAN CLUB LICENSE ANSWER THE FOLLOWING DOES THE APPLICANT, A MEMBER OF THE APPLICANT'S IMMEDIATE FAMILY (SPOUSE, CHILDREN, PARENTS, IN- LAWS OR SIBLINGS) OR ANY PERSON WITH A BENEFICIAL INTEREST IN THE SUBJECT LICENSE OF THIS APPLICATION, HAVE ANY INTEREST IN ANY OTHER NEW JERSEY ALCOHOLIC BEVERAGE LICENSE? Yes x No IF THE ANSWER IS “YES,” COMPLETE THE FOLLOWING BY LISTING THE NEW JERSEY LIQUOR LICENSE TWELVE DIGIT NUMBER(S) AND THE NAME(S) OF THE PERSON(S) OR CORPORATION(S) WHO HOLD(S) SUCH INTEREST. USE ADDITIONAL PAGE(S) 7 AS NEEDED. A. License Number - - . Name (Last Name, First Name, Middle Initial or Corporate Name) Relationship to Applicant B. License Number = 7 Name (Last Name, First Name, Middle Initial or Corporate Name) Relationship to Applicant C. License Number - = % Name (Last Name, First Name, Middle Initial or Corporate Name) Relationship to Applicant 7.2 WOULD ANY PERSON OR CORPORATION NAMED IN THIS APPLICATION FAIL TO QUALIFY FOR OWNERSHIP OF THE LICENSE IF APPLYING AS AN INDIVIDUAL BECAUSE OF AGE, CRIMINAL CONVICTION OR PROHIBITED INTERESTS IN OTHER LICENSES? yes __X No IF THE ANSWER IS “YES,” ANSWER THE FOLLOWING BY INSERTING THE NAME OF THE INDIVIDUAL OR CORPORATION AND, IF AN INDIVIDUAL, THE SOCIAL SECURITY NUMBER AND DATE OF BIRTH. USE ADDITIONAL PAGE(S) 7 AS NEEDED n/a Name (Last Name, First Name, Middle Initial or Corporate Name) Social Security Number . - OR NJ Sales Tax Certificate of Authority No Date of Birth / i
File revisions (1)
- Sep 29, 2026
d0597015545a7,049,693 bytes