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Page 2 PLEASE TYPE OR PRINT ALL INFORMATION <br /> STATE ASSIGNED LICENSE NUMBER 0722- 44 -946 - nng <br /> Application is made on behalf of: 2 <br /> 1 =An Individual 2=Business Corporation 7= Limited Liability Company <br /> 3=A Partnership 4=Unincorporated Club <br /> 5=Incorporated Club 6=Limited Partnership <br /> 2.1 NAME(S)AS IT DOES OR WILL APPEAR ON THE LICENSE CERTIFICATE(NOT"TRADE"NAME): <br /> License may be held by Individual(Last Name, First Name,Middle Initial), Partnership or Corporation. <br /> E.G. Holding Corp. — WPAr ftr-„ga <br /> (Last Name,First Name, Middle Initial or Corporate Name) <br /> IF <br /> 2.2 ACTUAL ADDRESS WHERE THE LICENSE IS TO BE USED(SITED PREMISES): ` I <br /> Street Address 495 Prospect Avenue, Essex Green Shopping C.Pnter .111 <br /> Number Street Name <br /> Municipality West Orange Zip n7pS9 - <br /> Telephone number of business (13 ) 124 q — <br /> Area Exchange 089Number <br /> 2.3 If no licensed premises exists or If a mailing address is different than the"actual address"given above,provide the mailing addres <br /> (insert N/A if not applicable)', <br /> Street Address 103 Yost Blvd., Suite •101 <br /> Number Street Name <br /> P.O. Box#_^ Municipality Pittsburgh State pA <br /> 15221 Telephone( 412 ) 825 - 0579 <br /> Zip <br /> 2.4 New Jersey Sales Tax Certificate of Authority No. 223358650 <br /> 2.5 TRADE NAME(S) UNDER WHICH BUSINESS IS TO BE CONDUCTED. ALL TRADE NAMES MUST BE LISTED AND <br /> REGISTERED WITH THE N.J.SECRETARY OF STATE if a corporation)OR COUNTY CLERK[if a partnership or sole proprietor]: <br /> Trital Wine & More <br /> 2.6 THE FOLLOWING QUESTIONS ARE TO BE ANSWERED BY ALL APPLICANTS OTHER THAN APPLICANTS FOR A NEW <br /> LICENSE: <br /> A. IS THE LICENSE ACTIVELY USED AT AN OPERATING PLACE OF BUSINESS? <br /> XX Yes No <br /> B. IF NO, GIVE THE DATE THE BUSINESS STOPPED OPERATING (OR THE DATE THE LICENSE WAS ORIGINALLY <br /> ISSUED IF NEVER SITED AT AN OPERATING BUSINESS): <br /> / <br /> C. IF THE LICENSE IS INACTIVE AND THE APPLICATION IS FOR A TRANSFER,WILL THE LICENSE BE USED AT AN <br /> • OPERATING PLACE OF BUSINESS AFTER APPROVAL? <br /> Yes No <br /> 2.7 THE FOLLOWING QUESTIONS ARE TO BE ANSWERED BY AN APPLICANT FOR A NEW LICENSE: <br /> A. WILL THE LICENSE BE USED AT AN OPERATING PLACE OF BUSINESS IMMEDIATELY UPON ISSUANCE? <br /> _ Yes No <br /> B. IF NO PROVIDE ANTICIPATED DATE OF LICENSE ACTIVATION: <br /> I f <br />