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• <br /> Page 11 PLEASE TYPE OR PRINT ALL INFORMATION <br /> 0722 44 046 008 AFFIDAVIT <br /> STATE ASSIGNED LICENSE NUMBER - <br /> LICENSE PERIOD 2013 TO 2014 DATE: <br /> APPLIED FOR FROM <br /> State of MO rls. IQiUGY ) SS: • <br /> County of 1"(D�c)t3D e � <br /> As provided by law(R.S.33:1-35), <br /> (Check One) <br /> 1. The Individual Applicant <br /> 2. Members of the Partnership Applicant <br /> Robert L. Trone of E.G. Holding Corporation Inc. • <br /> 3. (Corporation or Club Name) <br /> (a the li licensed President) <br /> consent(s)that the licensed premises and all portions of the building constituting the licensed premises,including all rooms,cellars,closets, <br /> out-buildings,passageways,vaults,yards,attics and every part of the structure of which the licensed premises are a part and all buildings <br /> used in connection therewith which are in his/her/their possession or under his/her/their control, may be inspected and searched without <br /> or <br /> warrant at all hours by the Director of the Division of Alcoholic Beverage Control, his or her duly authorized.deputies, inspectors a d <br /> investigators and all other sworn law enforcement officers,and being duly sworn according to law,upon his/her/their oath(s),depose(s) <br /> say(s)that he/she is(they are)the person(s)duly authorized to sign the application,that in instance of corporate ownership,the signator is • ' <br /> authorized by corporate resolution to sign on behalf of the corporations; and that the contents of this application represent complete <br /> disclosure of the fact,and that the contents of this application are true. <br /> (Signature of Individual Agent/Sole Proprietor) <br /> (Corporations Only) <br /> Attestation by Corporate Secretary <br /> (Partnership Name) <br /> (Signature of Partner) <br /> E.G. Holding Corporation Inc. <br /> Attest: <br /> Corporate Name (Signature of Partner) <br /> By -,/ of Partner) <br /> Secretary (Signature of Corporate President or Vice President) (Signature <br /> Signature <br /> Affix Corporate Seal (Signature of Partner) <br /> Sworn to and subscribed before me /3 <br /> this , � day of Q 20 ! <br /> CHERYL A.COLE <br /> AFFIDAVIT MUST BE SIGNED HERE —I- NOTARY PUBLIC <br /> (Signature o. • icerA•ministering Oath) Commission Expires 07/11/2015 <br /> BY DULY AUTHORIZED G her f( At C / <br /> NOTARY PUBLIC (Printed Narse'of Officer/A�dmlinistering Oath) 7��/r��/�• <br /> OR AN ATTORNEY-AT-LAW l vO r pU"'( 7o <br /> OF NEW JERSEY• • (Title of Office ministering Oath) (Date of Expiration of <br /> Commission, if applicable) <br /> i <br />