35-22 Exhibit A - Extension of Agreement for Affordable Housing Administrative Services with CGPH - 2022.pdf

!■ I STOCKHOLDER DISCLOSURE CERTIFICATION Name of Business: IX I certify that the list below contains the names and home addresses of all Stockholders, Partners, or Sole Proprietor holding 10% or more of the issued and outstanding stock of the undersigned.* OR L I certify that no one stockholder owns 10% or more of the issued and outstanding stock of the undersigned. ■ * IMPORTANT NOTICE TO BIDDERS SEE NEXT PAGE ; Check the box that represents the type of business organization: □Partnership CCorporation DSoie Proprietorship uLimited Partnership ^Limited Liability Corp. xLimited Liability Pstácietsfep □SubchapterS Corporation Company Sign and notarize the form below, and, If necessary, complete the stockholder list below. Stockhoiders. Partners, or Sole Proprietor: Name: Randall Gottesman Name: Home Address: n Inverness Lane Home Address: East Windsor, NJ 08520 Name: Name: Home Address: Home Address: Name: Name: i Home Address: Home Address: Z ubscribed and sworn before me thiso?0 day of kZ .2 (Affiant) i (Notary Public) m Randall Gottesman, President (Print name & title of affiant) My Commission expires: STEPHANIE C RUBIN Commission #50098692 [CONTINUED ON NEXT PAGE] Notary

rint name & title of affiant) My Commission expires: STEPHANIE C RUBIN Commission #50098692 [CONTINUED ON NEXT PAGE] Notary Public, State of NewJersey MyCommission Expires _______ February 12,2024 _____ 10 !