STATE QF NEW .

]ERSEY
DEPARTMENT OF ].,AW & PUBLIC SAFETY
LI cATlo N Fo R
D r v r s r oN o F AL cogol, r c
"-""tft"*i""'tt"t't'*tr
PO BOX 087, TREITfTON,
N,J 08525
RETAIL RENEWAIJ APPIJICATION FOR 2013-2014 IJICENSE TERM
SALES TAX AUIHORI TY
ISSUING AUTI{ORITY:
LICENSE TYPE:
LICENSE STATUS :
LICENSE NAIV1E :
TRADE NAME(S) :

NLMBER: 22339A257QQ] LICENSE NUMBER:

TOWNSHI P OF WEETAWKEN

2013-2

45L6

t i\

515

A Y"'T

PARK AVE

WEETAWKEN

N.J 07087

4'1"'

PARK AVE

NJ 07087
,/
IS LICENSE BEING ACTIVELY USED AT AN ACTUAL PREMfSE? TLl YBS ()
rF NO, ON r{}IAT DATE WAS THE LICENSE LAST USED? _/ _/ _
WEEHAWKEN

NO

******************1*,'**t******************lr****t**t*t*t********************
rla
STATE OF
)

couNrY

oF

r,

'YJ

ffljd8t +
---7-'----l-

SS:

LICENSEE OR PARTNER OR PRESIDENT OR VICE PRESIDENT OF CORP.

BEING DULY SWORN ACCOR-DING TO LAW, UPON HIS/HER OATI{ DEPOSES AND SAYS:
(T) INFORMATION CONTAINED ON THIS LICENSE RENEWAII PRINTOUT, AND AS
CONTAINED IN THE MOST COMPLETE FULL APPIJICATION ON FILE AS UPDATED OR
AIV1ENDED BY THE ATTACHMENTS HERETO, TS TRUE AND COMPLETE. (2) IF THE
LICENSEE IS A CORPORATION OR A PARTNERSHI P, I AM DULY AUTHORIZED TO FILE

(S

IGNA
OR PRESID

SWORN

IVIDUAI
VI

CE

LTCENSEE OR GENERAL PARTNER,

-.PTI.ESIDENT OF CORPORATION)

,'i'

TO AND

DAY OF

NOTARY OR

AFFIX

CORPORATE SEA],

,20]-3

OATH)

PRIITTED NAME AND TITLE OF NOTARY OR ATTORNEY)

(NOTARY SEAI IF APPIJICABLE)

* |l * * * * * * * * * * it * * * * * * * * * * * * * * * *

ssl

slI\L/-llt

RESERVED AREA

**r**r***********,*l************r
DArE FILED

srArE FEE $ J?tn,el

Lt3U&0i3
DATE RENEWAL GRANTED /
OR DENIED /
/
/
ARE SPECTAL CONDTTIONS TMPOSED FOR THE 20!3-2074 TERM? ( ) yES (
NO
MUNrcrpAL

MUNICI PAL
S

IGNATURE

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

STATE COPY

oerr-r:-oor-"sdffJ

PLENARY RETAIL CONSUMPTION LICENSE

BUSINESS CORPORATION
ED & JOES TAVERN INC
ED & .JOEIS TAVERN INC

LICENSED PREMISES ADDRESS

MAIIJING ADDRESS

L,@o)

r(

130:43-.'}5

LOAOS

TR#:

STATE OF NEW JERSEY

DEPARTMENT OF LAW AND PUBLIC SAFETY
DIVISION OF ALCOHOUC BEVERAGE COIfTROL

FFF'
DATE:

RETAIL LIQUOR UCENSE APPLICATION

STATE ASSIGNED LICENSE NUMBEB

f o?r/

,41

-aar-

[For DIVISION use only

-/-coDE

Action lD Code

tlAWDU
tt ttrl

a{f

0 c19

DATE APPLICATION FILED:

4-,5,2Dt9

TYPE OF LTCENSE (CHECK ONE)

THIS APPLICATION IS FOR:

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

31
dF

-{r

_
l/

Club

A New License

Plenarv Retail ConsumDtion

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

wBioad Packaoe Privileoe

Plenary Retait corisumptiori

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

Plenary Retail ConsumDtion

(HoteuMotel Exceptibn)

Change of Corporate Struclure

Plenarv Retail Consumotion

Cfheatre Exception)

Extension of License (to Executor.

Receiver, Administrator, etc.)

Seasonal Retail Consumption

(November 15 through April 30)

Seasonal Retail ConsumDtion

(May 1 through November 14)
44

Plenary Retail Distribution

43

Limited Retail Distribution

Renelval of License
Amendment of Application on File
Other

OTHER
14

Annual State Permit

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

40

Special Permit for a Golf Facilitv

(NJAC 13:2-5.31

-' r,

, ,/"?y, '[',

This Area is Reserved for Municipal Use

Municipal Fee $

ercdiveoate

(As Stated in Res

U , /)

/3

Date of resolution unless otherwise established.)

e'ffi*

(aF

.J

(i (-)

i:-.-::

Siate Fee $
=l

Date Denied
(As Stated in Resokrtion|

it

Retund Amount $
Special Conditions Attached:

13rj1545.9

,NS

PLEASE TYPE OR PRINT ALL INFORMATION

STATE ASSIGNED LICENSE

NUMBER?F//

Application is made on behalf

of: tl

- At - eod- eod

2.'l

7 = Limited Liability Company

2 = Business Corporation
4 = Unincorporated club

1 = An Individual
3 = A Partnership
5 = Incorporated Club

6 = Limited Partnership

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

Municipality

Ll5l\o

Number
Wc<-tro"*ryr

Telephone number of
2.3

NIA

business t

Aucflrr'<-

Street Name

A'ot I
Area

4l-o

- 7tl'f

Exchange

Number

lf no licensed premises exists or ifa mailing address is difierent than the 'actual address' given above, provide the mailing addres
(insert N/A if not applicable):
Street Address

Number

Street Name

P.O. Box #

Municipality

Zip_-_

Telephone

New Jersey Sales Tax Certificate of Aut noarl

2.5

?ark

State

(-)

uo. 4

L' l l a {/ *U

TRADE NAME(S) UNDER WHTCH BUSTNESS rS TO BE CONDUCTED. ALL TRADE NAMES MUST BE LISTED AND
REGTSTERED W|TH THE N.J. SECRETARY OF STATE lif a corporationl oR couNTY CLERK [if a partnership orsole prcprietor]:

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

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

Yes
IF NO, GIVE THE DATE THE BUSINESS
B. -Y--

STOPPED OPERATING (OR THE DATE THE LICENSE WAS ORIGINALLY

ISSUED 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 AN
OPEMTING PLACE OF BUSINESS AFTER APPROVAL?

t,ll$

2.7

ves

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

A
B.

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

N/ A

ves-No

No

IF NO, PROVIDE ANTICIPATED DATE OF LICENSE ACTIVATION;

NIA r-

t-

JUL-@9-e413 16:43

From;LEGAL REGULAT0RY

g7lgAl2073 ATt'a

Poge

281866S763

AFF

Pase:3/6
PA6E 03

To: ?6591
CLERK oFFICE

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

srArE AaBG Eo

o.il.*Nut*sER

Lr

6l//- fi

'""E'-tt{

ffi f;-Ai#;'ffi ;;d-F;:ii't1fi nb;;*gr1T9.11M1I*3i1IT,11o-trin":g

$.HL:;ffi
;ild'ilii{l*d;';ffi;;':1;ii dftN,iiF'mr!0dl6bre' fftortaeN/Assatm''ErEqudionll'qctdan22qtP:E!
? rlrod4 ah6
3.

bC r*lrd tJAl
r{ow
lf

mor! tfBn oo! buildlng

ultDd|re ile,tdr

An

r.z
3.3

ANY 8EPARATE EU ll.elNce ARE TO SE lilcLuoED Ul'lDR THIS

aurmtrvc

oa

13

itp

rcgqrda Plgr 3 k io be |ttnttH 6r,stlng o'dl Erbhg

d Fl]hiaao ahou5 be rubmt0d tb hdurbt In lhi 6iit' ABC littr ih'
To 8E LGENSED.

lo be Indldd urder ftb

cndt8

llg|'

on {

no. I

tlare, r

19 TtlE ENIIRE SUILDING To aE Ltcl{sED?

It lhr BnJE? to quGdoh 3 3 li 'ilo,' CFdry rt'jolt log.q

lb[o.hg quoat$r.
3.{ S|!ener(
1o

ioor

?r

ltoor

noor

8padry cEh

J|-

Ys

Yes /f.
!|t

lc

tr

under

No

licd|!

lr^aty.Fd.f|taourtrlo

Da

ll

||t fd

Dt anclrcflng

tE

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ruat /-vc

-Lt*Y.s /*tto
jlv"r -*
dldnnil ltr.|U|rh.r

|1d t lrldr qlGs

All ot

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lln'tt)

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lto

ruornl{* v-ND-.Ho
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rtto
^ltor
b b lttcfud u|6i tr. lcang O

f(l.d,

rltsdr..r,aD daLilet Oglrrlim uifh sJdE

lp

deoly.l.|haar ll{:.1i6d arErr

ftont unlbansd artas.

3'5

AflE At{Y GRoUI|DS ADJAQE.{T Yo Tl{E B{,IDNG U]{oER UccHeE

m||rsEs? f
Y"J \,/
_

3.6

PAtrf oF Tt{E ucHsEo

oE t||cu,DED

^s

.]tb

T}rs ucGI{sE oR EETV\GEII UCENSED

tB TURE Ar{y U LtCEitSED A,REA LocATEo BETI^,EN EULDTNGS l)ltlDER
ADJACEM OROUNDS?

tF THE At{aWER tS
IN FEET,

3,7 -'(6
oOES
tF

rt

'YEg.'

THE APFUCANT

^fi

olvtl

c{ A sxtfcH or

rtrE LICENSE! At uNucEXaED AREAS SHO{tlll{G DlilENB|o

THE Eull'oll'lc7

YEg.', tS THERE A iJ|ORTOAOE ON rlrE

ooEs

r,6

to

tultgllot

Pad[

THE APPLICAI.fr LEAS TH BUII'DING?

r'|r. i. r moq4e dr itrc FqdV, .nffiqucalon

3.c.

It

,f BlJe-

tlr lbnrad Frfllta

lr

vre /

Zno
'{-var -tto
-

ldaa. sl5|.r q,||'d.n 19.

MOFTGAGEE tllOLDR OF UORT{r GE}

Siral A&reeB
p.o.

sor* N/fl

Mlnldpdty

sr", tJ/F

Nlr

4
Dr

caFn

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hpDTosf

Uurtciprhy

P,O, Bor

tla

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L'teeax

No

t o I t t' tU'to7'oos

LfJI\9 YFS|- flvct-tv?

Nrerrnouer..r ,I{J

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F
d

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i:j
o
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?ALL

/iVENruE

fnZa6*,

8F6&lFrT

flo8b

PLEASE TYPE OR PRINT ALL INFORMATION

Page 4

sTATEASSIGNEDLIcENSENUMBER

4.1

O?ll Sl -ao{ - oo9"

IS THE NEAREST ENTRANCE OF THE PLACE TO BE LICENSED WTHIN 2OO FEET OF THE NEAREST
ENTMNCE OF ANY CHURCH OR SCHOOL?
t'to

Yes /

IF THE ANSWER IS 'YES," IS A WAIVER SIGNED BY THE APPROPRIATE OFFICIAL ATTACHED TO THIS

APPLICATION?

4,2
4.3

N,/A Yes _

DOES THE APPLICANT INTEND TO USE ANY VEHICLES FOR THE TMNSPORT OR DELIVERY OF
ALCOHOLIC BEVERAGES?
YES ./
NO (A TRANSIT INSIGNIA IS NECESSARY BEFORE
ALCOHOLIC BEVERAGES MAY BE TRANSPORTED.)
,

HAS THE APPLICANT FILED AN ANNUAL SPECIAL TAX REGISTRATION AND RETURN FORM (TTB F
5630.5) WITH THE FEDERAL ALCOHOL AND TOBACCO TAX AND TRADE BUREAU?

ves .',/
f

4.4

No

Ho

F "YES," DATE FTLED

_t

WILL ANY BUSINESS OTHER THAN THE SALEpF ALCOHOLTC BEVERAGES BE CONDUCTED ON THE
PREMISES TO BE LICENSED?
No

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

Nl$ n"rt"ur"nt

_
_
_
_
_
_
_

N/A_ Catering

$l/L HoteuMotel

NA Amusements
v/n
h,h

N.J. Lottery
Grocery or Delicatessen

-1-*

NA Other (speciry)
4.5

Applicant

Other

Applicant

Other

Applicant

Other

Applicant

Other

Applicant

Other

Applicant

Other

Applicant

Other

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
(Last Name, First Name or Corporate Name)

Street Address

uunicipatity
1
zip N ,J f-.

. rr

N/N

,1.,

State

1-\

/fr

NJ Sales Tax certificate of Authority trto,

.i"

;A

PLEASE TYPE OR PRINT ALL INFORMATION

sTATEASsTGNEDLTcENsENUMBEROT//

- ,0

aa{- oaf

ALL APPLIGANTS ANSVVER THE FOLLOWNG

5,1

IS THE APPLICANT OR ANY OTHER PERSON MENTIONED IN THIS APPLICATION A POLICE OFFICER

OR HOLD ANY POSITION ENTRUSTED WITH THE ENFORCEMENT OF ANY LAWS CONCERNING
ALCOHOLIC BEVERAGES IN ANY MANNER WFI,ATSOEVER?

Yes r'
n

No

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

Name of

individuat N/A

Last Name

First Name

Title of position held N l$r

Name of EmDlovino

5.2

Aoencv

Middle Initial

rrl,!
N

/lt

DOES THE APPLICANT OR ANY OTHER PERSON MENTIONED IN THIS APPLICATION. OR ANY
PERSON HAVING A BENEFICIAL INTEREST rN THE LTCENSF BUStNESS, HOLD OFFTCE tN THE UNtT
OF GOVERNMENT ISSUING THE LICENSE?
Yes
I'Io

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

Name of lndividual
Last Name

First Name

Title of Office
Municipality

5-3

DOES THE APPLICANT OR ANY OTHER PERSON MENTIONED IN THIS LICENSE APPLICATION, OR
ANYONE 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 OF
THE INTEREST AND COMPLETE THE FOLLOWNG:

A.

New Jersey license number, if

B.

IF THE BUSINESS DOES NOT HOLD A NEW JERSEY LIQUOR LICENSE, ANSWER THE FOLLOWING
QUESTIONS:

applicable ru ln

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

Street Address

nr

l\i

L,,1

F
Number

P.o. Box

# lJlA

zio hllA
TvDe of

Business NtiA

Street Name
Municipality NIF

st"t. N /F

Page 6

PLEASE TYPE OR PRINT ALL INFORMATION

srArE ASSIcNED LrcrNse Nur,rern

Z// ?, za{- eet

-

FOLLOWING
EVER BEEN DENIED A LIOUOR LICENSE tN NEW JERSEY?
ALL APPLICANTS ANSWER THE

6.'1

HAS THE APPLICANT

/
Yes J

No

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

oenied: Nh R"t"it

N l{
TVwarehouse
i
.ii
Unit of covemment which denied License or permit N lf
Date of Denial (approximate ifnot known) NIA
I
Reason for Denial NlA

Type of License or Permit

xJfi-

6.2

HAS ANY

N lA rransoortation

vwrolesale
Manufaclurer

--T-

CORPOMTION, PARTNERSHIP OR INDIVIDUAL MENTIONED IN THIS APPLICATION, OTHERTHAN THE

Yes /

APPLTCANT, BEEN DENIED A LIQUOR LICENSE OR PERMIT?

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

-.
- llrlt+
NAme nt--Fnfltv ,Nt

I.Io

nerait

Denied:

Vvholesale

., ll.
''
-\S- Manufacturer {J$$-f-- Warehouse, \q!-which denied License or permlt t\lF

Type of License or Permit

Unit of Government

Date of Denial (approximate rf not

N/A

knownl
'

----1]--

Transportatlon

r-

Reason frlr Denial

6.3

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

N/f
Laqt Name
IV/h /-

lndividual

DATE OF ACTION

PENALW WAS TMPOSED BY:

Nr r-

N/F

lndicate whether by Division ofABC or identily Local lssuing Authorityl

PENALTY CONSISTED OF:

nr/F
r.-f/s.

N/n

FINEO

Middle lnitial

First Name
DOCKET NO.

NOT RENEVVED

lamountl

REVOKED

SUSPENDED

CANCELLED

(number of days)

orHER [exprainl

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 BEEN
CONVICTED OF A CRIMINAL OFFENSE?
Yes
No
' ANSWER THE FOLLOWING:
IF THE ANSWER IS
Name of lndividual
Name
First
Maddle Initial
|
|
Conviction Date
Date of Birth
,.^.,'L.h
State
Court of Jurisdidion
Description of offense (specific charge)

jl

A.

fr,/N _t

Name .1.
$l\-

-t
interest in entitv to be licensed
It applicable, provide the date the Director oflhe N.J. Oivision of Alcoholic Beverage Control issued an order approving
(No license may be issued without an order
or disapproving disqualifction removal:
from the oireclor of the Division of Alcdholic Beverage Control determining no disqualificabon or removing
disqualification.) (See R,S. 33:1-31.2 and XJIIQ. 13:2-'15.)

Nl$

Provide Agency DocXet f,fo.

:p'fru1- N

/\

/_/_.

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 SUBJECT

LICENSE OF THIS APPLICATION, HAVE ANY INTEREST IN ANY OTHER NEW JERSEY ALCOHOLIC
BEVERAGE LICENSE?

Yes J

No

IF THE ANSWER IS 'YES,' COMPLETE THE FOLLOWING BY LISTING THE NEW JERSEY LIQUOR
LICENSE 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.

A.

License

Numb*

VA
t

Relationship to Applican

B.

License
Name
(Last Name, First Name, Middle Initial or Corporate Name)
Relationship to Applicant

C.

License
Name

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

Relationship torApplicant
*****1*********t***********:l*+t**

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

7.?

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

Yr" -/

t'to

IF THE ANSWER IS 'YES,'ANSWER THE FOLLOWING BY INSERTING THE NAME OF THE INDIVIDUAL
OR CORPORATION AND THE SOCIAL SECURITY NUMBER AND DATE OF BIRTH, IF AN INDIVIDUAL, USE

ADDITIONAL PAGE(S) 7 AS NEEDED.

Name

(Last Name, First Name, Middle

Social Security t'tumoer

$\tr

NJ Sales Tax Certificate of Authority

Date of

,{
I r' t.\

Birth N[\{

or Corporate Name)

OR

No.

Y\lO-

-l

JUL-49-2413 16;43

gl/A8l20Lg

From: LEGAL REAJLATORY

2018668753

97154

AFF

To:46691

Pase i 4/ 6

PAGE 94

CLERK oFFICE

PlSAgE Tt?E oR FRIflT ALL tNFoRlilATloN

pqi o
sr^rE AseKfi{ED LrcalsE

NITMBERP?Z

!9 ' Pd- -eQf

0IooEETHEAPPUCANToRANYoNEMENT|oflED|NT.tlg|lPPUcAT|ol{ol/tGTHESTATEoFNEwJERSSYoR
on elcox.ollc-BE\'ruc-E- r x u+ttcH KAq
rHE uNrtED 9TAre6 dli ili'E-tGE'FEi' iErGirv' nneneer
SEVERAGE LAw oR Ar'lY
ACCRUED
'd,rxii PURSUANT

tew

iii fi;-i-co'Hotic
riv?

rFneeY oR FEDEML

-:4-

ra

dEl/ER^oE

t^W' THE ArcoHoLlc

No

A HOTEU OTEL

FOR
BEEN ISAUED, OR tS IT SEII{O REOUESTED TO 8E TgsUEO'
6.2 H s THE UCENSE
oF
AEr'i2.i'fl
F.8.
PRot/lsloNs
poaiilir-oii
THE
nrsnmcnoN
urtDER
irrE
ixcei'i-roi rg
-Yo
YGy'NO
lF rHE At{S'l /ER lB 'YE3.' tS lr Foq A HOTul,oTEL FACIUTY OF 60 OR tm R@f,s?
ixec< oNe: IJAL so RooMg IIA_ rm Rmrrg

6.3

^8

AN

10 EE ISSUED' AE A'lI EXCEFNON TO TTiE TI'IO

It'\S THE LICENSE OEEN ISSUD. OR IS IT EENG NEOUEBIED
BOwtlNo ALIEY 0R

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

Y.t ll- t{o
|NTERMT|OITIAL AIRPORT? .lF norrr'nrortl
or{E oF THE FoLltvllll{o;
- NrIJFtrrtnxartoMLArRFoRT
rF TtrF ANS$,ER ts 'YEg,'
-' ctlEcK
- -Ddil;o.'i-riiiiru-teY''

idfiiii-r,iliinnr

YHEFotLowlNG^REToBEA{SVI,EREoWHENAPP|.EATIoN|EFoRAL|cxSETRAIBFER'

a.4
8,5

LlcEraErdtr'ER';;t;;;t;eceieoo?Jl '

d*

&6

^?

' @{

'oo{

rflts ts A REouEsr FoR A pERsot$TopERsoN TRAnoFtR. INEEF ruuE(g) oF tERSoN (l$t l{dtr FiBt).
tF
'pnnnreRsHtp
on coRPoR^IlON CURRET'LY XOLDING.TIIE LICENSE:

Acel
tlritq

,rI#li'l flffiriffi"IF

THB |a

Nrnr,
Pr.AcFro-PlrcE TnANSFER oF

FocKFr ucEnsc (r{o sEeo PREI4BEs),

A REOUGST FOR A R.ACE.TOIPLACE TRANSFER OF A AITED

FRO VIITIICH IHE LICENSE IS TO BE TRANAFERRED

UCEN{I. |I{SEFT THE ADDFEgS

OF

THE

CURRENT SITE

s*., naor"n |tJ/fr

. }{unb..
r4oildpcllty N/F
-

zre

FJIA

SUle{

iltne

--

ibr

JGFGY

rHE FOLLoWNO ARe TE BE ANSIAGRO 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.

t ?-z t J3139-,
_ujDatE ol r.qr rDlc. 5
4-t3r'Jer?Cy JcrllJqI
NOT161
rO
PUELfSH
r{Etr\pAFER
a! NAME OF
rbr.

or

nrf. noecs

----=)-

CHAIIGE OF CORPORATE
CORPORA
THF
I r)I'VI;IG ARE TO EE Ai61/I'ERED
FEFOI{TIT{G A CI|/iIIGE
AT{S1/IERED SY CONP$ATOI{S
CONPORATIffS FEFORTIT{G
THE Frtl
FOI.LOWIIIG
g1gc5 !F THE
STNUCWTE VTIIC,NEN A T{EW STOCIOIOI-DEF ICQURES 1IORC Tll^N PEFCE{T OF 1Hg
'
UCEIISED COMPANY (ONE PUEUCAT(oi{ Of I{OTEE RCOTNREO)'

4.9

Dlbol

rpue$lE-

^
-.""-r'*ffi--*,*u"Glffi-

TflE FOLLOWNO OUESTIOI{6 ARE FOR CLUA UCEiTSE APFLICi{T Q'{LV:

IN ACTNG OPERATION tN THE STAIE OF' I{EW JERSEY FOR AT LEA6T IHREE YEARA
8.IO
- - HAS THE CI-US SET{
tluDt^fLy pRroR to THE auBitl@br.l oF rls APPLICATION FoR A LlcENsE?

-t

COnrnuo.rsly
Nlf Yrr

S,,t

C}TAPTER OR
IS THE APPLTCANI A CONSTIflJEiIT UNfT. CHARTEREO OR OTXERIftIISE DULY ENFRAN.JEED
METBER CLUA OF A t'tATlOltlAL OR STATE ORDER?

NIA
8.t2

vea

-No

HA$ THE cLU6 HID

ExcluarvE FossES&or| A'{D Us

-ro
g HA\ aT LEASI
CL(
8.r3 DqES THE
l'lo
Yrr
-tO
liU.h- vcr

GO

oF cLU!

VOTING MEMBERIrI

otARlERIr FoF IHREE cd.f'|Nuor,6 YC^Ay'

Page

s'rAr

PLEASE ryPE OR PRINT ALL INFORMATION

LtcENsE NUMBER

^sstcNEp

9.1

Z?!L - -29_

Zej{ e ejt
-

ALL APPLICANTS ANSWER THE FOLLOWING

DOES ANY INDIVIDUAL, PARTNERSHIP, CORPOMTION OR ASSOCIATION

QIIIEBfSNJEE.APEIIQATI HAVE

AN INTEREST DIRECTLY OR INDIRECTLY IN THE LICENSE APPLIED FOB OR IS THE STOCK OF ANY
STOCKHOLDER IIELD

II..t

ESCROW OR PLEOGED IN ANY

WAY?

Yes /

No

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

of Individual (Last Name First) or Corporation

(Last Name, First Name, Middle Initial or
on
Social Security t'tumoer
NJ Sales Tax
of Authority Number r*

-$p-

--,-----

Address N
.r.^ Number Street Name
P.O. Box * N l/Y{
N,runicipatity
tr}lS
n.Azip NlY-.l - _
Street

state..-f---NIA

Describe Natura of lnterest

0.2

DOES ANY INDIVIDUAL. PARTNERSHIP. CORPORATION OR ASSOCTATION HOLD ANY CHATTEL MORTGAGE OR
CONDITIONAL BILL OF SALE OR OTHER SECURITY INTEREST ON ANY FURNITURE. FIXTURES, GOODS OR
EQUIPMENT TO BE USED IN PONNECTION WITH THE BUSINESS TO BE OPERATED UNDER THE LICENSE

APPLIED FOR?

_Yes

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

idd:I"'"

First Name. Middle Initial or

-oR

NJ Sales Tax Cenificate of Authority f.lumber

Street Address

P.o. Box

Stre.elName
r Number
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 TO
RECEIVE ORAGREED TO PAY ANYONE (BY WAY OF RENT, SALARY OR OTHERWISE) ALL OR AIIY PERCENTAGE
oF THE GROSS RECE|PTS OR NET pROFtT OR |NC9ME DERTVED FROM THE BUSTNESS TO BE CONDUCTED
No
UNDER THE LICENSE APPLIED FOR?

_Yes

_jl:_

IF THE ANSVGR IS 'YES,' ANSVVER THE FOLLOWNG USING A SEPARATE PAGE 9 FOR EACH INDIVIDUAL OR
CORPOMTION 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 Scurity

Number

-_

NJ Sales Tax Certificate o/Authority Number

Street Address
P.O. Box #

Municipality

-71

zip

Describe Nature of Interest

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

Page 10

srATE AssrcNED Lrcer.rse Nuft,teen

PLEASE TYPE OR
r{ PRINT
FXIN I ALL INFORMATION
INFOR

f//

.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,iE
LTCENSEE CoMPANY txe panrut.conponeiroir'iiir
il'e' iiiEils-eo- cor'r"eruv, n-o-LoiriCi6ilFo", on
AFFILIATED rN rHE coRPoRArE cHAiN,
orHERWrsE
MUsrANiwei riiie'dir'o'wno usrr.rc e sepiili'ipXEE'r'o
pnce ron ron
EA.H coRpo*roN. ANSV'ER ouesnor.r.
nHo
orri b-ri;; bo* '';.A1il
f GE joA RoR EA.H coRpo*loN.
10.1 Nameofcoporarion (JoepER2 p.
10.2

PLneE. LLL

Att

Stueet address of home office

u)a

Street Name
[4unicipality
State
10.3

zip

NJ Sales Tax Certificate

O1bfl6-

ofAuthority Number

10.4

5r.r",sit8il!,Sj\",,ifiEf,,.riJlr#"=,fi,J_ririivFE

rs

our oF srArE, REpoRr BELowTHE

ADDREss oF ANy

Street Address

Street Name
Municipality

New JeFey

zip

10.5 ls THE

i0.6

4""

TION NOWAN EXISTING, VALID CORPORATTON?

DATE cHARTERED oR

tNcoRpoaerco /Z

10.7 CERTIFICATE OF INCORPORATION

-"

10,8 IF NOT INCORPORATED

t af

NUMBER

Ao/1 -*o
STATE
stare

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;

5^t#?iffsJ3;:is6;SisERr

.*#"

*.uo*ED

By rHE oFFrcE oF rHE sEcRErARy

oF srArE rN

rHE DArE oF REVocAloN, oR

rF

suspENDED, rHE

BEGTNNTNG AND ENDTNG

Date of revocation
Eegid,ning date

enoinltcate

t' tt

EJ^.,ilJl? #...++?TXT(..:^.I_'-$_REGT'TERED oR AUTH._REED AGENT TN NEWJERsEy upoN WH.M

ALcoHoLrc BEVE*oGE *#"r,l5?:FE?:1,",:
,ensev
3?lLrCnr,rr,-eiiisunru:i.io.ii.e,
atco'oJd lgfgs^II1.^
b-E0eilbilii';.,f%HdiJE;,,$,1,1]?#:i^T,".Ji'.'

ii..,"#&ffiir:m?=rf#irH-e
|tane -l-,,/R I?F

A(A lo

1)an.ofr

"=w

Ll

/1r-. Slere

or Corporation)
Street Address
Municipality

,,070/h-_

New Jersey

relephonen^ae,t

4p_l
Area

, a1O - 2/Zf
Number

Exehange
10.'t1 IF THE LTCENSED COMPANY IS OW\,IEgJ]YOTHER
CORPO*oTION(S) OR-IS IN A CORPORATECHAIN,
ATl ACH A

B$r"Ffff""rT,SJ'iBJl"u,T:I*ojfIr_IE^+If+!![!dp

;H"A?ERcENTAGE oF srocK rNreRLsr

rru

rrr

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

//n

M/TT
I

PAge

1OA

PLEASE TYPE oR PRINTALL INFoRIVATIoN

srArE AsslcNED LtcENsE NIMBERz.,

q// rlf

AeE _DAf

ALL APPLICANTS ANS\A/ER THE FOLLOWNG

tADD PAGES AS NECESSARYI
SOLE OWNERS AND PARTNERSHtpS: Comptete this page in tu

LlMlrED PARTNERSHIPS: All informatjon about a gneral partner or partnes

of a limited partnership must be reponed, Mether the
g8neral parlner is an individual or a corpolgtion, n'ii"t
ot $ie names Jnd
_aooresses of all limit8d partners must be submitted as an
with an identirication of the percntase oGalir timiteo partner
as it reriiel io ioiJ owrership of tne business

:[i,flil"#i$l':#plication

c0RPoRAT|oNs: All corporation applicants or.license-es and any corpo.ation that.has

an ownerchip inlerest in lhe corpo.atjoo under
l'cense or t0 be licensed must have been reported on Page
10. iniorfirtion on this page, roa, wriiiJe"tinr lrr oficers, directors
and
stockholde$ holding one percnt or mor6 of tlie snares of th-e re"pecti*
crrrj ri,irri""i r"li'rjin jrie!'or omcers and directors
and attach a cunent membershiD list
"o.np"ny.
NAME OF CORPOMTION OR CLUB COVERED BY THIS
PAGE (COMPLETE ONLY IF APPLICANT OR SIOCKHOLDER
IS A

CORPORATION OR PARTNERSHIP)

PO

Bg#-

Municipality

Srate

-lhl

s^"o1si,h

::1:'.'iio^"01-t
number

Home telephone

Area

Exchange

(_)
Area
Exchange
Number
%of business owned or contlolled
4fO 7p
Check position that appties: _
Sote o\mer
_ iartner _
Office telephone

_
-

_
Name

of

number

Prasident

vice-President

Trustee _

Manager

Beneficiary

_other

(last name tirst)

Stockholder

--

Treasurer

secretary

_ Agent- _
(speciry) -melh BER:
,

Number of shares

Director

Executor/Administrator _

Receiver

officer or

Last
Home Street Address
P.O. Box #

Municipality

Social Security Number

Home Glephone

number

"oteidr'-

(_

Area
Offcs lelephone number ( _

A,r"

Number

- / --E;i;;!;- -

Number

controltea
tTh/O
position
Check
that applies: _
partner .
Sole owner _
_ president _ Vice_president _ Secretary _
Truslee _
Manager
-r{-ngent
Beneficiary
Other (speciry)
_
_
%of business owned or

Number of shares
Stockhotder
Treasurer

-Executo./Administrator

Director
Receiver

Page

PLEASE TYPE OR PRINT ALL INFORMATION

11

srArEAssrGNEDL*enseNuuaea

?/J fl? -QeE--cos'

AFFIDAVIT

LICENSE PERIOO
APPLIED FOR

DATE:

State of
County of
As provided by law (R.S. 33:'1-35),
(Check One)

L
2.

The Individual Applicant

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, cllars, 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 without

wanant at all hours by lhe Director of the Division of Alcohotic Beverage Control, his or her duly authorized deputies, inspectors or
investigators 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 appliction are true.

(Corporations Only)
Attestation by Corporate Secretary

Ailest:
(Signature of Partner)
By

(Signature of Partner)

Secretary
Signature

(Signature ot Partner)

Atfix Corporate Seal

Suom lo and subscribed before me

zo
AFFIDAVIT MUST BE SIGNED HERE

BY DULY AUTHORIZED
NOTARY PUBLIC
OR AN ATTORNEY.AT-LAW
OF NEW JERSEY

l3

(Printed Name of Officer Administering Oath)

Ar^n

Aol"'"'

F.

l{.k^."-" Ath^"'g

(Tite of Offlcer Administering Oath)

c.* Ae..-l
(Date of Exoiration of
Commission, if applicable)