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Page 8 PLEASE TYPE OR PRINT ALL INFORMATION STATE ASSIGNED LICENSE NUMBER 0722 44 046 008 ALL APPLICANTS ANSWER THE FOLLOWING 8.1 DOES THE APPLICANT ANY ANYONE MENTIONED P TYT NTERESTCORIO ALCOHOLIC BEVERAGE TAX WHICH HAS THE UNITED STATES ANY LICENSE ACCRUED PURSUANT TO THE ALCOHOLIC BEVERAGE TAX LAW, THE ALCOHOLIC BEVERAGE LAW OR ANY OTHER NEW JERSEY OR FEDERAL LAW? Yes XX No 8.2 HAS THE TO LATHE POPULATION N ISSUED, UNDER THE PROVISIONS OF R.S. 33A HOTEL/MOTEL 0 AS AN EXCEPTION Yes XX No IF THE ANSWER IS'YES," IS IT FOR A HOTEUMOTEL FACILITY OF 50 OR 100 ROOMS? CHECK ONE: 50 ROOMS 100 ROOMS 8.3 LHAS THE ICENSE LICENSE LIMITATION LAW`(R.S OR 33I 1-123 2l)N FOR REQUESTED OTEUMOTE,ISSUED,AS AN EXCEPTION TO THE TWO .BOWLING ALLEY OR INTERNATIONAL AIRPORT? _-_Yes EX No HOTEL/MOTEL THE ANSWER IS°YES,°CHECK OBOWLINGEALLEY FOLLOWING: INTERNATIONAL AIRPORT RESTAURANT THE FOLLOWING ARE TO BE ANSWERED WHEN APPLICATION IS FOR A LICENSE TRANSFER. 8.4 LICENSE NUMBER SOUGHT TO BE TRANSFERRED - 8.5 REQUEST FOR A CORPORATIONO PERSN-TO-PERSON TRANSFER,INSERT HOLDING THE LICENSE: OF PERSON(Last Name First), PARTNERSHIP (Last Name,First Name,Middle Initial or Corporate Name) 8.6 IF THIS IS A REQUEST FOR A PLACE-TO-PLACE TRANSFER OF A POCKET LICENSE(NO SITED PREMISES), MARK AN X HERE: IF'THIS IS A REQUEST FROM FOR AH THE LICE NSE P IS T LACTO TRANSFER ROF A SITED TED,LICENSE,INSERT THE ADDRESS OF THE CURRENT SITE Street Address Name ame Number New Jersey Municipality Zip THE FOLLOWING ARE TO BE ANSWERED BY APPLICANTS FOR A NEW LICENSE OR A LICENSE TRANSFER. 8,7 INSERT THE ANTICIPATED DATES WHEN PUBLIC NOTICE OF APPLICATION WILL BE PUBLISHED. PUBLICATION MAY NOT BE SOONER THAN THE DATE OF WILL BE PUBLISHED. PUBLICATION M LING OF THIS APPLICATION, Date of first notice l Date of second notice / 8,8 NAME OF NEWSPAPER TO PUBLISH NOTICE 8.9 THE FOLLOWING ARE TO BE ANSWERED BY CORPORATIONS REPORTING A CHANGE OF CORPORATE STRUCTURE E WHEREIN E(ONE PUBLICATION STOCKHOLDER D R ACQUIRES IRES MORE THAN 1 PERCENT OF THE STOCK OF THE LICENSED Date of notice I Name of newspaper publishing notice THE FOLLOWING QUESTIONS ARE FOR CLUB LICENSE APPLICANTS ONLY: 8.10 CONTINUOUSLY IMMEDIATELY PRIOR TOITHE SUBMISSIOTN OF ITS APPLICATION FOR A L IC THREE YEARS U Yes No 8.11 IS THE APPLICANT A CONSTITUENT UNIT, CHARTERED OR OTHERWISE DULY ENFRANCISED CHAPTER OR MEMBER CLUB OF A NATIONAL OR STATE ORDER? Yes No B.12 HAS THE CLUB HAD EXCLUSIVE POSSESSION AND USE QF CLUB QUARTERS FOR THREE CONTINUOUS YEARS? Yes No 8.13 DOES THE CLUB HAVE AT LEAST 60 VOTING MEMBERS? Yes No