Conference/Public Meeting Agenda/Documents — Packet

Section 3.01 Respondent Disclosure Statement Respondent Disclosure Statement must be fully and accurately completed. IF YOU FAIL TO PROPERLY COMPLETE THIS RESPONDENT DISCLOSURE STATEMENT, THEN YOUR PROPOSAL SHALL RESULT IN REJECTION. 1. Business Form: Indicate the business form by placing an “X” in the appropriate box: o Corporation a Partnership . . XK —_—Other- if other, specify: Limutad Liadbil4y Comeany List the names and addresses of all individuals, partners or other entities that have a 10 percent or more interest in the corporation or partnership. If none, then state none. Name Address 1. Leonard Prvello | Caven 9+. Avenue, Jersey City, NT 07205 2Nichdlas Vene | Caven?t Avenue Jersey Gty, NJ 0730S an