2013-2014 Application to ABC Board for liquor license by Councilwoman's LLC

LICENSED PREMISES

MAIIJING ADDRESS :

RETAIL

SALES TAX AUIHORI TYISSUING AUTI{ORITY:LICENSE TYPE:LICENSE STATUS :

LICENSE NAIV1E :

TRADE NAME(S) :

LICENSE

t i\A Y"'T4'1"'

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L,@o)STATE QF NEW .]ERSEY

DEPARTMENT OF ].,AW & PUBLIC SAFETYD r v r s r oN o F AL cogol, r c

"-""tft"*i""'tt"t't'*tr LI cATlo N Fo R 2 0 1 3 - 2 0 1 4

PO BOX 087, TREITfTON, N,J 08525RENEWAIJ APPIJICATION FOR 2013-2014 IJICENSE

NLMBER: 22339A257QQ] LICENSE NUMBER:

TERM

TOWNSHI P OF WEETAWKENPLENARY RETAIL CONSUMPTIONBUSINESS CORPORATIONED & JOES TAVERN INCED & .JOEIS TAVERN INC

ADDRESS : 45L6 PARK AVEWEETAWKEN N.J 07087

4 515 PARK AVEWEEHAWKEN NJ 07087 ,/

IS LICENSE BEING ACTIVELY USED AT AN ACTUAL PREMfSE? TLl YBS () NO

rF NO, ON r{}IAT DATE WAS THE LICENSE LAST USED? _/ _/ _******************1*,'**t******************lr****t**t*t*t********************

rlaSTATE OF

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couNrY oF ffljd8t + )

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SS:

BEING DULY SWORN ACCOR-DING TO LAW, UPON HIS/HER OATI{ DEPOSES AND SAYS:(T) INFORMATION CONTAINED ON THIS LICENSE RENEWAII PRINTOUT, AND ASCONTAINED IN THE MOST COMPLETE FULL APPIJICATION ON FILE AS UPDATED OR

AIV1ENDED BY THE ATTACHMENTS HERETO, TS TRUE AND COMPLETE. (2) IF THELICENSEE IS A CORPORATION OR A PARTNERSHI P, I AM DULY AUTHORIZED TO FILE

( S IGNA IVIDUAI LTCENSEE OR GENERAL PARTNER,OR PRESID VI CE -.PTI.ESIDENT OF CORPORATION) AFFIX CORPORATE SEA],

SWORN,'i'

TO AND DAY OF

NOTARY OR OATH)

LICENSEE OR PARTNER OR PRESIDENT OR VICE PRESIDENT OF CORP.

* |l * * * * * * * * * * it * * * * * * * * * * * * * * * * * RESERVED AREA **r**r***********,*l************rMUNrcrpAL ssl slI\L/-llt srArE FEE $ J?tn,el DArE FILED Lt3U&0i3DATE RENEWAL GRANTED / / OR DENIED / /

MUNICI PAL

S IGNATURE

( PRIITTED NAME AND TITLE OF NOTARY OR ATTORNEY)(NOTARY SEAI IF APPIJICABLE)

ARE SPECTAL CONDTTIONS TMPOSED FOR THE 20!3-2074 TERM? ( ) yES ( r( NO

NAME OF I S SUING .A.I]THOR] TY

STATE COPY

130:43-.'}5

LOAOS

Action lD Codetl tt ttrlAWDU

TR#:

FFF'

DATE:

STATE ASSIGNED LICENSE NUMBEB -

f o?r/ ,41 -aar- a{f 0-/--

STATE OF NEW JERSEYDEPARTMENT OF LAW AND PUBLIC SAFETYDIVISION OF ALCOHOUC BEVERAGE COIfTROL

RETAIL LIQUOR UCENSE APPLICATION

c19. DATE APPLICATION FILED:

4-,5,2Dt9[For DIVISION use only _ ]

coDE TYPE OF LTCENSE (CHECK ONE)

CLASS C LICENSES [R.S. 3:l:1121

31 _ Club

44

43

OTHER

14

40

THIS APPLICATION IS FOR:

dF-{r

l/ Plenarv Retail ConsumDtionwBioad Packaoe Privileoe

-

Plenary Retait corisumptiori

A New License

Person-to-Person Transier(lncludino Partnershio chanoe-except Li-mited Partnbrship)- '

Plac€-to-Place Transier(lncluding expansion of premises)

Change of Corporate Struclure

Extension of License (to Executor.Receiver, Administrator, etc.)

Renelval of License

Amendment of Application on File

Other

Plenary Retail ConsumDtion(HoteuMotel Exceptibn)

Plenarv Retail ConsumotionCfheatre Exception)

Seasonal Retail Consumption(November 15 through April 30)

Seasonal Retail ConsumDtion(May 1 through November 14)

Plenary Retail Distribution

Limited Retail Distribution

Annual State Permit(R.S. 33:1-42, NJAC 13:2-52)

Special Permit for a Golf Facilitv(NJAC 13:2-5.31

This Area is Reserved for Municipal Use

, ,/"?y, '[Municipal Fee $

Date Denied(As Stated in Resokrtion|

Retund Amount $

Special Conditions Attached:

e'ffi*-' r,(aF .J

(i (-)

i:-.-:: e

=l

it

ercdiveoate U , /) ',

/3(As Stated in Res Date of resolution unless otherwise established.)

Siate Fee $

13rj1545.9

,NS

STATE ASSIGNED LICENSE

PLEASE TYPE OR PRINT ALL INFORMATION

2 = Business Corporation4 = Unincorporated club6 = Limited Partnership

NUMBER?F// - At - eod- eodApplication is made on behalf of: tl

1 = An Individual3 = A Partnership5 = Incorporated Club

7 = Limited Liability Company

2.'l NAME(S) AS IT DOES OR VVILL APPEAR ON THE LICENSE CERTIFICATE (NOT'TMDE' NAME):

Ucense may be held byFdividual (Last Nq{ne, First Name, Middle Initial), Partnership or Corporation.

Ceo 7'Middle lnitial or Corporate Name)

2.2 ACTUAL ADDRESS WHERE THE LICENSE IS TO BE USED (SITED PREMISES):

street nooress Ll5l\o ?ark Aucflrr'<-Number Street Name

Municipality Wc<-tro"*ryrTelephone number of business t A'ot I 4l-o - 7tl'f

Area Exchange Number

lf no licensed premises exists or ifa mailing address is difierent than the 'actual address' given above, provide the mailing addres2.3

NIA(insert N/A if not

Street Address

applicable):

2.5

Zip_-_ Telephone (-)

New Jersey Sales Tax Certificate of Aut noarl uo. 4 L' l l a {/ *UTRADE NAME(S) UNDER WHTCH BUSTNESS rS TO BE CONDUCTED. ALL TRADE NAMES MUST BE LISTED ANDREGTSTERED W|TH THE N.J. SECRETARY OF STATE lif a corporationl oR couNTY CLERK [if a partnership orsole prcprietor]:

Number Street Name

P.O. Box # Municipality State

THE FOLLOWING QUESTTONS ARE TO BE ANSV\IERED BY ALL APPLICANTS OTHER THAN APPLICANTS FOR A NEWLICENSE:

A IS THE LICENSE ACTIVELY USEO AT AN OPERATING PLACE OF BUSINESS?

-Y-- Yes

B. IF NO, GIVE THE DATE THE BUSINESS STOPPED OPERATING (OR THE DATE THE LICENSE WAS ORIGINALLYISSUED IF NEVER SITED AT AN OPERATING BUSINESS):NIA r- t-

c. tr rie ltceusE ts tNAcrtvE AND THE AppLrcATroN rs FoR A TRANsFER, wLL THE LtcENsE BE usED AT ANOPEMTING PLACE OF BUSINESS AFTER APPROVAL?t,ll$ ves

-No

THE FOLLOWING QUESTIONS ARE TO 8E ANSWERED BY AN APPLICANT FOR A NEW LICENSE:

A WILL THE LICENSE BE USED AT AN OPERATING PLACE OF BUSINESS IMMEDIATELY UPON ISSUANCE?

N/ A ves No

2.7

B. IF NO, PROVIDE ANTICIPATED DATE OF LICENSE ACTIVATION;NIA r- t-

srArE AaBG Eo Lr o.il.*Nut*sER 6l//- fi '""E'-tt{

JUL-@9-e413 16:43g7lgAl2073 ATt'a

From;LEGAL REGULAT0RY AFF To: ?6591281866S763 CLERK oFFICE

J|- Ys -- I'b

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Pad[

p.o. sor* N/fl Mlnldpdty Nlr4

Dr caFn 9

8tF.l AidleEt

P,O, Bor t

Pase:3/6PA6E 03

Poge l pLEASE Iy?tE OR pRtitT AL! lttlFORr,tATtOt{

$.HL:;ffi ffi f;-Ai#;'ffi ;;d-F;:ii't1fi nb;;*gr1T9.11M1I*3i1IT,11o-trin":g;ild'ilii{l*d;';ffi;;':1;ii dftN,iiF'mr!0dl6bre' fftortaeN/Assatm''ErEqudionll'qctdan22qtP:E!? rlrod4 ah6 bC r*lrd tJAl

3. I r{ow t ANY 8EPARATE EU ll.elNce ARE TO SE lilcLuoED Ul'lD€R THIS UCENger lln'tt)lf mor! tfBn oo! buildlng 13 lo be Indldd urder ftb tlare, r rcgqrda Plgr 3 k io be |ttnttH 6r,stlng o'dl Erbhg

An ultDd|re ile,tdr oa itp cndt8 llg|' d Fl]hiaao ahou5 be rubmt0d tb hdurbt In lhi 6iit' ABC littr ih'

All ot ll Yrr

ruat /-vc -

lto

ruornl{* v-ND-.Ho

^ltor Nil Yc6 dA ilo

8padry cEh dldnnil lt€r.|U|rh.r b b lttcfud u|6i tr. lcang O

lr^aty.Fd.f€|taourtrlo Da f(l.d, rltsdr..r,aD daLilet Oglrrlim uifh sJ€dE lp deoly.l.|haar ll{:.1i6d arErrftont unlbansd artas.

3'5 AflE At{Y GRoUI|DS ADJAQE.{T Yo Tl{E B{,IDNG U]{oER UccHeE to oE t||cu,DED ^s

PAtrf oF Tt{E uc€HsEom€||rsEs? f_ Y"J \,/ .]tb

3.6 tB TU€RE Ar{y U LtCEitSED A,REA LocATEo BETI^,EN EULDTNGS l)ltlDER T}rs ucGI{sE oR EETV\GEII UCENSED

tF THE At{aWER tS 'YEg.' ^fi c{ A sxtfcH or rtrE LICENSE! At€ uNucEXaED AREAS SHO{tlll{G DlilENB|o s

IN FEET,

3,7 oOES THE APFUCANT olvtl THE Eull'oll'lc7

tF YEg.', tS THERE A iJ|ORTOAOE ON rlrE tultgllotooEs THE APPLICAI.fr LEAS€ TH€ BUII'DING?

rt r'|r. i. r moq4e dr itrc FqdV, .nffiqucalon 3.c. It tlr lbnrad Frfllta lr ldaa. sl5|.r q,||'d.n 19.

vre / tla

- '- Zno,f BlJe- {-var - -tto

r,6 MOFTGAGEE tllOLD€R OF UORT{r GE}

ADJACEM OROUNDS?

-'(6

sr", tJ/F

r.z aurmtrvc no. I on { To 8E LGENSED.

3.3 19 TtlE ENIIRE SUILDING To aE Ltc€l{sED? Yes /f. No

It lhr BnJE? to quGdoh 3 3 li 'ilo,' CFdry rt'jolt log.q !|t lc tr under licd|! |1d t lrldr qlGs ||t fd Dt anclrcflng tElb[o.hg quoat$r.

3.{ S|!ener(

1o ioor

?r ltoor

f noor

Siral A&reeB

hpDTosf -Uurtciprhy /r.J'-

L'teeax e No t o I t t' tU'to7'oos LfJI\9 YFS|- flvct-tv?

Nrerrnouer..r ,I{J flo8b

r)gFdFi:jor\ |

fnZa6*, 8F6&l€FrT?ALL /iVENruE

Page 4 PLEASE TYPE OR PRINT ALL INFORMATION

Nl$ n"rt"ur"nt _ Applicant

_ Applicant

_ Applicant

_ Applicant

_ Applicant

_ Applicant

_ Applicant

Other

Other

Other

Other

Other

Other

Other

N/A_

$l/LNAv/n

h,h-1-*

NA4.5 IF SOMEONE OTHER THAN THE APPLICANT WILL OPERATE THE OTHER BUSINESS ON THE LICENSED

PREMISES, ANSWER THIS QUESTION. IF THERE IS MORE THAN ONE INDIVIDUAL OR COMPANY.ATTACH A SEPARATE PAGE LISTING THE REQUESTED INFORMATION FOR EACH OPERATOR.

Business to be oper"t"o N lA-----------:-

Name of companylinoivioual N iS

Street Address

. rr ,1.,uunicipatity N/N State 1-\ /fr

1 .i"zip N ,J f-. -

-

NJ Sales Tax certificate of Authority trto, N ;A

sTATEASSIGNEDLIcENSENUMBER O?ll Sl -ao{ - oo9"

4.1 IS THE NEAREST ENTRANCE OF THE PLACE TO BE LICENSED WTHIN 2OO FEET OF THE NEARESTENTMNCE OF ANY CHURCH OR SCHOOL?

-

Yes / t'to

IF THE ANSWER IS 'YES," IS A WAIVER SIGNED BY THE APPROPRIATE OFFICIAL ATTACHED TO THISAPPLICATION? N,/A Yes _ No

4,2 DOES THE APPLICANT INTEND TO USE ANY VEHICLES FOR THE TMNSPORT OR DELIVERY OFALCOHOLIC BEVERAGES?

-

YES ./ NO (A TRANSIT INSIGNIA IS NECESSARY BEFOREALCOHOLIC BEVERAGES MAY BE TRANSPORTED.)

4.3 , HAS THE APPLICANT FILED AN ANNUAL SPECIAL TAX REGISTRATION AND RETURN FORM (TTB F5630.5) WITH THE FEDERAL ALCOHOL AND TOBACCO TAX AND TRADE BUREAU?

ves .',/ Ho

f F "YES," DATE FTLED _ | _t _4.4 WILL ANY BUSINESS OTHER THAN THE SALEpF ALCOHOLTC BEVERAGES BE CONDUCTED ON THE

PREMISES TO BE LICENSED?

-YeS

V No

IF THE ANSWER IS 'YES,' INDICATE THE NATURE OF THE BUSINESS AND WI-IO WLL CONDUCT IT BYRESPONDING TO THE FOLLOWING QUESTIONS:

Catering

HoteuMotel

Amusements

N.J. Lottery

Grocery or Delicatessen

Other (speciry)

(Last Name, First Name or Corporate Name)

PLEASE TYPE OR PRINT ALL INFORMATION

sTATEASsTGNEDLTcENsENUMBEROT// - ,0 - aa{- oafALL APPLIGANTS ANSVVER THE FOLLOWNG

5,1 IS THE APPLICANT OR ANY OTHER PERSON MENTIONED IN THIS APPLICATION A POLICE OFFICEROR HOLD ANY POSITION ENTRUSTED WITH THE ENFORCEMENT OF ANY LAWS CONCERNINGALCOHOLIC BEVERAGES IN ANY MANNER WFI,ATSOEVER?

/Yes r' No

n *J"n"*.-, n *s.' comDrete the forrowino:

Name of individuat N/Ai Last Name

Title of position held N l$rFirst Name Middle Initial

rrl,!Name of EmDlovino Aoencv N /lt

5.2 DOES THE APPLICANT OR ANY OTHER PERSON MENTIONED IN THIS APPLICATION. OR ANYPERSON HAVING A BENEFICIAL INTEREST rN THE LTCENSF BUStNESS, HOLD OFFTCE tN THE UNtTOF GOVERNMENT ISSUING THE LICENSE?

-

Yes / I'Io

IF THE ANSWER IS "YES," COMPLETE THE FOLLOWING:

Name of lndividualLast Name First Name

Title of Office

Municipality

5-3 DOES THE APPLICANT OR ANY OTHER PERSON MENTIONED IN THIS LICENSE APPLICATION, ORANYONE WITH A BENEFICIAL INTEREST IN THE LICENSED BUSINESS, DIRECTLY OR INDIRECTLY,HAVE ANY INTEREST IN ANY BREWERY, WNERY, DISTILLERY, RECTIFYING AND BLENDING PLANT,IMPORTER OR WHOLESALE ALCOHOLIC BEVERAGE BUSINESS, AS OW{ER, PART OWNER,LANDLORD, TENANT, MORTGAGE HOLDER ORAS A STOCKHOLDER. OFFICER, DIRECTOR. AGENT.EMPLOYEE OR OTHERWISE?

v", / t,to

IF THE ANSWER IS 'YES," ATTACH AN AFFIDAVIT EXPLAINING THE RELATIONSHIP AND NATURE OFTHE INTEREST AND COMPLETE THE FOLLOWNG:

A. New Jersey license number, if applicable ru ln

B. IF THE BUSINESS DOES NOT HOLD A NEW JERSEY LIQUOR LICENSE, ANSWER THE FOLLOWINGQUESTIONS:

n r L,,1

Street Address l\i FNumber

P.o. Box # lJlA Municipality

zio hllA

Street Name

NIF st"t. N /F

Name of eniity conducting business (Corporation, PartneGhip or Individual)

TvDe of Business NtiA

Page 6 PLEASE TYPE OR PRINT ALL INFORMATION

srArE ASSIcNED LrcrNse Nur,rern d Z// ?, - za{- eetALL APPLICANTS ANSWER THE FOLLOWING /

6.'1 HAS THE APPLICANT EVER BEEN DENIED A LIOUOR LICENSE tN NEW JERSEY? Yes J No

N lA rransoortation--T-

Unit of covemment which denied License or permit N lfDate of Denial (approximate ifnot known) NIA I

Reason for Denial NlA6.2 HAS ANY CORPOMTION, PARTNERSHIP OR INDIVIDUAL MENTIONED IN THIS APPLICATION, OTHERTHAN THE

APPLTCANT, BEEN DENIED A LIQUOR LICENSE OR PERMIT?

-

Yes / I.IoIF THE ANSWER IS"YES," ANSWER THE FOLLOWING:-. -- - llrlNAme nt Fnfltv ,Nt t+

Reason frlr Denial

6.3 HAS THE OR ANY OTHER PERSON. CORPORATION OR ENTITY MENTIONED IN THIS LICENSEAPPLICATION, OR ANYONE WTH A BENEFICIAL INTEREST IN IT, HAD AN INTEREST IN A NEW JERSEYALCOHOLIC EEVERAGE LICENSE V*IICH WAS SURRENDERED, SUSPENDED OR HAD A PENALTY IMPOSED INLIEU OF SUSPENSION, NOT RENEVVEO, REVOKED OR CANCELLED WITHIN THE lOYEARS PRIOR TO THE DATEOF THIS APPLICATION? _Yes,/ wolF THE ANSWER lS 'YES,' PROVIDE DETAILS OF EACH BELOW lcomplete a separate Page 6 for each aclion]:

Name of lndividual N/fLaqt Name First Name

DATE OF ACTION IV/h /- I

-

DOCKET NO.

tF THE ANSWER TO TH|S QUESTTON lS 'YES," ANSVVER THE FO|IOWTNG:

Type of License or Permit oenied: Nh R"t"it N l{ vwrolesalexJfi- warehouse TV- Manufaclurer

.ii i

Nr r-PENALW WAS TMPOSED BY: N/F

lndicate whether by Division ofABC or identily Local lssuing AuthoritylPENALTY CONSISTED OF:

Type of License or Permit Denied: ., ll. nerait -\S-

Vvholesale {J$- Transportatlon

$-f-- Warehouse, \q!-- Manufacturer ' '

Unit of Government which denied License or permlt t\lFDate of Denial (approximate rf not knownl N/A l r-' ----1]--

Middle lnitial

FINEO $ NOT RENEVVED

REVOKED

-

CANCELLEDlamountl

SUSPENDED

N/n orHER [exprainl

(number of days)

6.4 HAS THE APPLICANT OR ANY OTHER PERSON OR CORPORATION MENTIONED IN THIS LICENSE APPLICATION.ORAI.IYONE WITH A BENEFICIAL INTEREST IN THE BUS,INESS UNDER LICENSE OR TO BE LICENSED, EVER BEENCONVICTED OF A CRIMINAL OFFENSE?

-

Yes jl No' ANSWER THE FOLLOWING:

Name

nr/F

r.-f/s.

A. IF THE ANSWER ISName of lndividual

Date of Birth fr,/N | _t _,.^.,'L.h

First Name .1. Maddle InitialConviction Date $l\- |

-t

-State Court of JurisdidionDescription of offense (specific charge)

interest in entitv to be licensed

It applicable, provide the date the Director oflhe N.J. Oivision of Alcoholic Beverage Control issued an order approvingor disapproving disqualifc€tion removal: Nl$ /_/_. (No license may be issued without an orderfrom the oireclor of the Division of Alcdholic Beverage Control determining no disqualificabon or removingdisqualification.) (See R,S. 33:1-31.2 and XJIIQ. 13:2-'15.)

Provide Agency DocXet f,fo. :p'fru1- N /\

A. License Numb* VA

tRelationship to Applican

B. License

Name

C. License

Name

PLEASE ryPE OR PRINT ALL INFORMATION

srArEAsslcNEDlrceNseNutureen 47l/ - 9? eA{--eo{ALL APPLICANTS OTHER THAN CLUB LICENSE ANSWER THE FOLLOWNG

7.1 DOES THE APPLICANT, A MEMBER OF THE APPLICANT'S IMMEDIATE FAMILY (SPOUSE, CHILDREN,PARENTS, IN.LAWS OR SIBLINGS) OR ANY PERSON WTH A BENEFICIAL INTEREST IN THE SUBJECTLICENSE OF THIS APPLICATION, HAVE ANY INTEREST IN ANY OTHER NEW JERSEY ALCOHOLICBEVERAGE LICENSE?

Yes J No

IF THE ANSWER IS 'YES,' COMPLETE THE FOLLOWING BY LISTING THE NEW JERSEY LIQUORLICENSE TWELVE DTGIT NUMBER(S) AND THE NAME(S) OF THE PERSON(S) OR CORPORATION(S)WHO HOID(S) SUCH INTEREST. USE ADDITIONAL PAGE(S) 7 AS NEEDED.

(Last Name, First Name, Middle Initial or Corporate Name)

Relationship to Applicant

(Last Name, First Name. Middle Initial or Corporate Name)

Relationship torApplicant

tt*********1H*******t*t*tt+*aittt**t****tt*t***r**** *****1*********t***********:l*+t**

7.? WOULD ANY PERSON OR CORPORATION NAMED IN THIS APPLICATION FAIL TO QUALIFY FORO\^/NERSHIP OF THE LICENSE IF APPLYING AS AN INDIVIDUAL BECAUSE OF AGE, CRIMINALCONVICTION OR PROHIBITED INTERESTS IN OTHER LICENSES?

Yr" -/ t'to

Social Security t'tumoer $\tr -

IF THE ANSWER IS 'YES,'ANSWER THE FOLLOWING BY INSERTING THE NAME OF THE INDIVIDUALOR CORPORATION AND THE SOCIAL SECURITY NUMBER AND DATE OF BIRTH, IF AN INDIVIDUAL, USEADDITIONAL PAGE(S) 7 AS NEEDED.

Name(Last Name, First Name, Middle I or Corporate Name)

OR

INJ Sales Tax Certificate of Authority No. Y\lO-,{I r' t.\Date of Birth N[\{ I

-l -

JUL-49-2413 16;43gl/A8l20Lg 97154

a!4.9

From: LEGAL REAJLATORY AFF To:466912018668753 CLERK oFFICE

Pase i 4/ 6PAGE 94

0IooEETHEAPPUCANToRANYoNEMENT|oflED|NT.tlg|lPPUcAT|ol{ol/tGTHESTATEoFNEwJERSSYoRrHE uNrtED 9TAre6 dli ili'E-tGE'FEi' iErGirv' nneneer on elcox.ollc-BE\'ruc-E- r x u+ttcH KAq

ACCRUED PURSUANT iii fi;-i-co'Hotic dEl/ER^oE ra t^W' THE ArcoHoLlc SEVERAGE LAw oR Ar'lY'd,rxii tew rFneeY oR FEDEML t riv?

-Yo -:4- No

6.2 H s THE UCENSE BEEN ISAUED, OR tS IT SEII{O REOUESTED TO 8E TgsUEO' FOR A HOTEU OTEL ^8

AN

ixcei'i-roi rg irrE poaiilir-oii nrsnmcnoN urtDER THE PRot/lsloNs oF F.8. AEr'i2.i'flYGy'NO

lF rHE At{S'l /ER lB 'YE3.' tS lr Foq A HOT€ul,oTEL FACIUTY OF 60 OR tm R@f,s?ixec< oNe: IJAL so RooMg IIA_ rm Rmrrg

6.3 It'\S THE LICENSE OEEN ISSU€D. OR IS IT EENG NEOUEBIED 10 EE ISSUED' AE A'lI EXCEFNON TO TTiE TI'IO

gcE cE UMtTA oN'r w-d.i.-3s.;.i, tzl FoF n rcreuruorrL, RESTAUMNT, BOwtlNo ALIEY 0R

|NTERMT|OITIAL AIRPORT? .- Y.t ll- t{o

rF TtrF ANS$,ER ts 'YEg,' ctlEcK or{E oF THE FoLltvllll{o; N lF norrr'nrortlidfiiii-r,iliinnr -' - -Ddil;o.'i-riiiiru-teY'' - rIJFtrrtnxartoMLArRFoRT

YHEFotLowlNG^REToBEA{SVI,EREoWHENAPP|.EATIoN|EFoRAL|c€xSETRAIBFER'

a.4 LlcEraErdtr'ER';;t;;;t;eceieoo?Jl ' ^?

' @{ 'oo{

pqi o PlSAgE Tt?E oR FRIflT ALL tNFoRlilATloN

sr^rE AseKfi{ED LrcalsE NITMBERP?Z !9 ' Pd- -eQf

8,5 tF rflts ts A REouEsr FoR A pERsot$TopERsoN TRAnoFtR. INEEF ruuE(g) oF tERSoN (l$t l{dtr FiBt).'pnnnreRsHtp

on coRPoR^IlON CURRET'LY XOLDING.TIIE LICENSE:

d * Aceltlritq Nrnr,

&6 ,rI#li'l flffiriffi"- ^ Pr.AcFro-PlrcE TnANSFER oF A FocKFr ucEnsc (r{o sEeo PREI4BEs),

IF THB |a A REOUGST FOR A R.ACE.TOIPLACE TRANSFER OF A AITED UCEN{I€. |I{SEFT THE ADDFEgS OF THE

CURRENT SITE FRO VIITIICH IHE LICENSE IS TO BE TRANAFERRED

s*., naor"n |tJ/fr -. }{unb.. SUle{ iltner4oildpcllty N/F - - ibr JGFGY

zre FJIA --rHE FOLLoWNO ARe TE BE ANSIAGR€O BY APPLICAI{TE FoR A t{E11, UCElttsE OR A LlCEtgE InATEFEF

8.7 tHsERT THE Anrnc|PArED DATEB w{EN puSllc r{oTtcE oF APPtlcATtoN wLL BE PUEusrlED, P(lSLlcAYlol{ITAY iIOT BE SMNER TT{AN THE CNTE OF FIUNG OF THIS APPLrcATION.

drbr. or nrf. noecs ----=)- t ?-z t J3-DatE ol r.qr rDlc. 5 139-, -t3r-j- _u- 4- tNAME OF r{Etr\€pAFER rO PUELfSH NOT161 'Jer?Cy JcrllJqITHF Frtl I r)I'VI;IG ARE TO EE Ai61/I'ERED SY CONP$ATOI{S FEFOI{TIT{G A CHAIIGE OF CORPORATHE FOI.LOWIIIG ARE TO EE AT{S1/IERED SY CONPORATIffS FEFORTIT{G A CI|/iIIGE OF CORPORATE

STNUCWTE VTIIC,NEN A T{EW STOCIOIOI-DEF ICQURES 1IORC Tll^N '

PEFCE{T OF 1Hg g1gc5 !F THE

UCEIISED COMPANY (ONE PUEUCAT(oi{ Of I{OTEE RCOTNREO)'I

Dlbol rpue$lE- I

-t

^-.""-r'*ffi--*,*u"Glffi-TflE FOLLOWNO OUESTIOI{6 ARE FOR CLUA UCEiTSE APFLICi{T€ Q'{LV:

8.IO HAS THE CI-US SE€T{ IN ACTNG OPERATION tN THE STAIE OF' I{EW JERSEY FOR AT LEA6T IHREE YEARA- - COnrnuo.rsly tlu€Dt^f€Ly pRroR to THE [email protected] oF rls APPLICATION FoR A LlcENsE?

Nlf Yrr

-NoS,,t 1 IS THE APPLTCANI A CONSTIflJEiIT UNfT. CHARTEREO OR OTXERIftIISE DULY ENFRAN.JEED C}TAPTER OR

METBER CLUA OF A t'tATlOltlAL OR STATE ORDER?

NIA vea

-ro8.t2 HA$ THE cLU6 HID ExcluarvE FossES&or| A'{D Us€ oF cLU! otARlERIr FoF IHREE cd.f'|Nuor,6 YC^Ay'

U.h- vcr

-tO8.r3 DqES THE CL( g HA\€ aT LEASI GO VOTING MEMBERIrI

li- Yrr

- l'lo

Page Is'r Ar E

^sstcNEp LtcENsE NUMBER Z?!L - -29_ - Zej{ - e ejt

ALL APPLICANTS ANSWER THE FOLLOWING

9.1 DOES ANY INDIVIDUAL, PARTNERSHIP, CORPOMTION OR ASSOCIATION QIIIEBfSNJEE.APEIIQATI HAVEAN INTEREST DIRECTLY OR INDIRECTLY IN THE LICENSE APPLIED FOB OR IS THE STOCK OF ANYSTOCKHOLDER IIELD II..t ESCROW OR PLEOGED IN ANY WAY? Yes / No

PLEASE ryPE OR PRINT ALL INFORMATION

IF THE ANSVVER IS 'YES," ANSVVER THE FOLLOWNG USING A SEPARATE PAGE 9 FOR EACH INDIVIDUAL ORCORPOMTION OF INTEREST. ATTACH A SEPARATE PAGE OF EXPLANATION IF MORE SPACE IS NEEDED.

(Last Name, First Name, Middle Initial orSocial Security t'tumoer -$p- --,----- -

-

on

of Individual (Last Name First) or Corporation

NJ Sales Tax of Authority Number r* hStreet Address N

.r.^ Number Street NameP.O. Box * N l/Y{ N,runicipatity tr}lSn.A-zip NlY-.l - _

state NIA..-f----

Describe Natura of lnterest

0.2 DOES ANY INDIVIDUAL. PARTNERSHIP. CORPORATION OR ASSOCTATION HOLD ANY CHATTEL MORTGAGE ORCONDITIONAL BILL OF SALE OR OTHER SECURITY INTEREST ON ANY FURNITURE. FIXTURES, GOODS OREQUIPMENT TO BE USED IN PONNECTION WITH THE BUSINESS TO BE OPERATED UNDER THE LICENSEAPPLIED FOR? _Yes J tto

IF THE ANSWER IS "YES,'ANSWER THE FOLLOWNG USING A SEPARATE PAGE 9 FOR EACH INDIVIDUAL OR, CORPORATION TO BE REPORTED. ATTACH A SEPARATE PAGE OF EXPI"ANATION IF MORE SPACE IS NEEDED.

Individual (Last Name First) or Corporation

Social Security Number

NJ Sales Tax Cenificate of Authority f.lumber

First Name. Middle Initial or-oRidd:I"'"

Street Address

^. r Number Stre.elNameP.o. Box # fv/|r Municipatity lv/l{ state

-

zip

-

Describe Nature of lnterest

9.3 HAS THE APPLICANTAGREED TO PERMTTANYONE NOT HAVING AN OWNERSHIP INTEREST IN THE LICENSE TORECEIVE ORAGREED TO PAY ANYONE (BY WAY OF RENT, SALARY OR OTHERWISE) ALL OR AIIY PERCENTAGEoF THE GROSS RECE|PTS OR NET pROFtT OR |NC9ME DERTVED FROM THE BUSTNESS TO BE CONDUCTEDUNDER THE LICENSE APPLIED FOR? _Yes _jl:_ No

IF THE ANSVGR IS 'YES,' ANSVVER THE FOLLOWNG USING A SEPARATE PAGE 9 FOR EACH INDIVIDUAL ORCORPOMTION TO BE REPORTED. ATTACH A SEPARATE PAGE OF EXPLANATION IF MORE SPACE IS NEEDED.

Name pf Individual (Last Name First) or Corporation

First Name

Social S€curity Number . -_NJ Sales Tax Certificate o/Authority Number

Municipality

zip

-

Describe Nature

APPLTCANTS THAT ARE SOLE PROPRIETORS OR PARTNERSHIPS GO TO PAGE TOA. CORPORATIONS AND LIMITED LIABILITYCOMPANIES COMPLETE PAGE 10.

Street Address

P.O. Box #

-71

of Interest

Page 10 PLEASE TYPE OR PRINT ALL INFORsrATE AssrcNED Lrcer.rse Nuft,teen D f// -

r{ FXIN I ALL INFORMATION.oos - AoJa

OUESTIONS TO BE ANSIA/ERED BY CORPORATTONC Ar,.,L,M,rE-o-L,AB,L,ry;"#;'"w^;:'"rH-g"ff^'i:rt"t}'Ellli'J,'.'#sii!i',."E{{,i!!l:,",..J,.diJ.?B:,i,sE+l,."J,iELTCENSEE CoMPANY txe panrut.conponeiroir'iiir il'e' iiiEils-eo- cor'r"eruv, n-o-LoiriCi6ilFo", on orHERWrsEAFFILIATED rN rHE coRPoRArE cHAiN, MUsrANiwei riiie'dir'o'wno usrr.rc e sepiili'ipXEE'r'o nHo pnce ron ronEA.H coRpo*roN. ANSV'ER ouesnor.r. orri b-ri;; bo* '';.A1il f GE joA

RoR EA.H coRpo*loN.

10.3

10.4

10.1 Nameofcoporarion (JoepER2 PLneE. LLLp.10.2 Stueet address of home office Att 4 u)a

Street Name[4unicipality

State zip O1bfl6-NJ Sales Tax Certificate ofAuthority Number

5r.r",sit8il!,Sj\",,ifiEf,,.riJlr#"=,fi,J_ririivFE rs our oF srArE, REpoRr BELowTHE ADDREss oF ANy

Street Address

Street NameMunicipality

New JeFeyzip

10.5 ls THE TION NOWAN EXISTING, VALID CORPORATTON?

i0.6 DATE cHARTERED oR tNcoRpoaerco /Z t a f , 410.7 CERTIFICATE OF INCORPORATION NUMBER

5^t#?iffsJ3;:is6;SisERr rHE DArE oF REVocAloN, oR rF suspENDED, rHE BEGTNNTNG AND ENDTNG

Date of revocation

Eegid,ning date

enoinltcate

|tane -l-,,/R I?F A(A lo 1)an.o- Ll /1r-. Slereor Corporation)

Street Address

MunicipalityNew Jersey

4"" -*oAo/1 stare

10,8 IF NOT INCORPORATED U]-" tgiHg*tri"J,fl.93,,pfrF".1ti_Sy^"[,il,.y.*EEi.liJ#',18._Effi:pffIl"[,?i.T,XF,,f,!

" t mi:*""i,-t#*"d; .*#" *.uo*ED By rHE oFFrcE oF rHE sEcRErARy oF srArE rN

t' tt EJ^.,ilJl? #...++?TXT(..:^.I_'-$_REGT'TERED oR AUTH._REED AGENT TN NEWJERsEy upoN WH.MALcoHoLrc BEVE*oGE *#"r,l5?:FE?:1,",: lgfgs^II1.^ 3?lLrCnr,rr,-eiiisunru:i.io.ii.e,

"=w ,ensevii..,"#&ffiir:m?=rf#irH-e atco'oJd b-E0eilbilii';.,f%HdiJE;,,$,1,1]?#:i^T,".Ji'.'

fr

,,070/h-_ relephonen^ae,t 4p_l , a1O - 2/ZfArea Exehange NumberIF THE LTCENSED COMPANY IS OW\,IEgJ]YOTHER CORPO*oTION(S) OR-IS IN A CORPORATECHAIN, ATl ACH AB$r"Ffff""rT,SJ'iBJl"u,T:I*ojfIr_IE^+If+!![!dp ;H"A?ERcENTAGE oF srocK rNreRLsr rru rrr

8,.#iil,"^J,: Fi"'+iEH3'"""""H"r8;ry:pJ#"T.;6'{;dil;",,J,ff5[""'+i]gFi,3i_?:"*.#Alis?""1],1!5

STATE

10.'t1

(rNDrvrDUALs, ennrruensnreg, f ssocinrrorusl.

t //nM/TTI

SOLE OWNERS AND PARTNERSHtpS: Comptete this page in tu .

LlMlrED PARTNERSHIPS: All informatjon about a g€neral partner or partnes of a limited partnership must be reponed, Mether theg8neral parlner is an individual or a corpolgtion, n'ii"t ot $ie names Jnd _aooresses of all limit8d partners must be submitted as an:[i,flil"#i$l':#plication

with an identirication of the perc€ntase oGalir timiteo partner as it reriiel io ioiJ owrership of tne business

c0RPoRAT|oNs: All corporation applicants or.license-es and any corpo.ation that.has an ownerchip inlerest in lhe corpo.atjoo underl'cense or t0 be licensed must have been reported on Page 10. iniorfirtion on this page, roa, wriiiJe"tinr lrr oficers, directors andstockholde$ holding one perc€nt or mor6 of tlie snares of th-e re"pecti* "o.np"ny.

crrrj ri,irri""i r"li'rjin jrie!'or omcers and directorsand attach a cunent membershiD list

PAge 1OA PLEASE TYPE oR PRINTALL INFoRIVATIoNsrArE AsslcNED LtcENsE NIMBERz., q// rlf - AeE _DAf

ALL APPLICANTS ANS\A/ER THE FOLLOWNG tADD PAGES AS NECESSARYI

NAME OF CORPOMTION OR CLUB COVERED BY THIS PAGE (COMPLETE ONLY IF APPLICANT OR SIOCKHOLDER IS ACORPORATION OR PARTNERSHIP)

PO Bg#- Municipality -lhl Srate

-::1:'.'iio^"01-t s^"o1si,h

-

Home telephone number (Area Exchange

Office telephone number (_)Area Exchange

%of business owned or contlolled 4fO 7p Number of shares --Check position that appties: _ Sote o\mer _ iartner _ Stockholder

-

Prasident

-

vice-President

-

secretary

-

Treasurer _ Director_ Trustee _ Manager _ Agent- _ Executor/Administrator _ Receiver_ Beneficiary _other (speciry) melh BER:

Number

, officer or

Number

"oteidr'-

Name of (last name tirst) ,

Municipality

LastHome Street Address

P.O. Box #

Social Security Number

Home Glephone number ( _Area

-

Truslee _ Manager

_ Beneficiary _ Other (speciry)

Offcs lelephone number ( _A,r" - / --E;i;;!;- - Number

%of business owned or controltea tTh/O Number of sharesCheck position that applies: _ Sole owner _ partner .

Stockhotder_ president _ Vice_president _ Secretary _ Treasurer _ Director

-r{-ngent -Executo./Administrator

Receiver

Page 11 PLEASE TYPE OR PRINT ALL INFORMATION

srArEAssrGNEDL*enseNuuaea o ?/J fl? - -QeE--cos'LICENSE PERIOOAPPLIED FOR

State of

County of

As provided by law (R.S. 33:'1-35),

(Check One)

L The Individual Applicant

2. Members of the Partnership Applicant

nf(Presidenwice-President) (Corporation or Club Name)

consent(s) thatthe licensed premises and all portions ofthe building constituting the licensed premises, including all rooms, c€llars, closets,

out-bualdings, passegeways, vaults, yards, attics and every part of the structure of which lhe licensed premises are a part and all buildings

used in mnnection lherewith which are in his,/her/their possession or under hivher/their @ntrol, may be inspecled and searched withoutwanant at all hours by lhe Director of the Division of Alcohotic Beverage Control, his or her duly authorized deputies, inspectors orinvestigators and all other sworn law entorcement officers, and being duly swom according to law, upon his'/hernheir oath(s), depose(s) and

say(s) that he/she is (they are) the person(s) duly authorized to sign the apdication, that in inslance of @rporate o nership. the signator is

authorized by corpofate resolution to sign on behalf of the corporations; and that the contents of this application represent complete

disclosure of the facl, and that the contents of this applic€tion are true.

(Corporations Only)Attestation by Corporate Secretary

Suom lo and subscribed before me

(Printed Name of Officer Administering Oath)Ar^n

Aol"'"' F. l{.k^."-" Ath^"'g(Tite of Offlcer Administering Oath)

AFFIDAVIT

DATE:

Ailest:

SecretarySignature

Atfix Corporate Seal

AFFIDAVIT MUST BE SIGNED HERE -

By(Signature of Partner)

BY DULY AUTHORIZEDNOTARY PUBLIC

OR AN ATTORNEY.AT-LAWOF NEW JERSEY

(Signature ot Partner)

zo l3

c.* Ae..-l

(Date of Exoiration ofCommission, if applicable)

(Signature of Partner)