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Page 10A PLEASE TYPE OR PRINT ALL INFORMATION STATE ASSIGNED LICENSE NUMBER 0722 - 44 - 046 - 008 ALL APPLICANTS ANSWER THE FOLLOWING[ADD PAGES AS NECESSARY) SOLE OWNERS AND PARTNERSHIPS: Complete this page in full. LIMITED PARTNERSHIPS: All information about a general partner or partners of a limited partnership must-be reported, whether the general partner is an individual or a corporation. A list of the names and addresses of all limited partners must be submittec as an attachment to this application with an identification of the percentage of each limited partner as it relates to total ownership of the business entity to be licensed. CORPORATIONS: All corporation applicants or licensees and any corporation that has an ownership interest in the corporation under -license or to be licensed must have been reported on Page 10, Information on this Page, 10A,-will identify all officers, directors and stockholders holding one percent or more of the shares of the respective company. Club licenses must list names of officers and directors and attach a current membership list. *********************************rye*******************************************.******A-k**************************** NAME OF CORPORATION OR CLUB COVERED BY THIS PAGE (COMPLETE ONLY IF APPLICANT OR STOCKHOLDER IS A CORPORATION OR PARTNERSHIP): E.G. Holding corporation Inc. Name of individual (last name first),stockholder, partner, officer or director: Trone, Robert L. Lest Name Middle Initial Home Street Address Number Street Name P.O. Box# Municipality_ State Zip Social Security Number Date of Birth Home telephone number (. Area Exchange Number Office telephone number ( 301 ) 795 - 1000 Area Exchange Number %of business owned or controlled 100% Number of shares 100 Check position that applies: Sole owner Partner XX Stockholder XX President Vice-President XX Secretary XX Treasurer Director Trustee Manager Agent Executor/Administrator Receiver Beneficiary Other(specify) Name of individual(last name first),stockholder, partner,officer or director: N/A Last Name First Name Middle Initial Home Street Address Number Street Name P.O. Box* Municipality State •. Zip - Social Security Number - - Date of Birth Home telephone number ( ) Area Exchange Number Office telephone number ( ) - Area Exchange Number %of business owned or controlled Number of shares Check position that applies: Soie owner Partner Stockholder President Vice-President Secretary Treasurer Director Trustee Manager Agent Executor/Administrator _Receiver Beneficiary Other(specify)