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6.-AMENDM ENT-Ch 5 0 <br /> p icers ersnip <br /> _nge,of Off 0 <br /> 5tqck or Own Interest <br /> ............ <br /> 613. CURRENT+ CER STOCK DR OWNERSHIP INTEREST <br /> ............ <br /> List the individuals and entities of the current ownership. Attach additional pages if necessary utilizing the format below. <br /> Name of Principal - Title/Position .......... ................................... Percentage of Ownership <br /> [0!jISTO ER D BARD PRESIDENT/DIRECTOR 0 CX0 <br /> ............ I........................................................ <br /> Name of Princi al Title/Position <br /> ............. ................ Perce-ntage of Ownership <br /> Fn 0/" <br /> LORRAINE J COFFEY' SECRETARYNP/DIRECTOR 0% <br /> ........... <br /> Name of Principal Title/Position Percentage of Ownership <br /> .......................... .............................. <br /> HOOVER ASURER/VICE PRESIDENT <br /> .................................................................................. 'I 1-1.................. <br /> Name of Principal .............. ............... Title/Position Percentage oft wnership <br /> ............ <br /> ........... ........... % <br /> NEW SEABURY PROPERTIES,LLC .........................I L10 0- <br /> OF ....... --------....... ..........-,................ <br /> Nallm,,e, of Principal Title/Position Percentage of Ownership <br /> '1�.............. ............ ......... ............................... <br /> NEW SEABURY REAL ESTATE HOLDINGS,LP OWNER 100% <br /> ....................... ..................... rvrvry ............. ............ ..... <br /> Name of Principal Title/Position Percentage of Ownership <br /> ...................................................................... .....................-­`­---­---­--­­`................. .......................................... ............................ .............................. <br /> AREP REAL ESTATE HOLDINGS,LLC O/C" <br /> OWNER 00% <br /> .................. ............................... <br /> 6A. INTEREST IN AN ALCOHOLIC BEVERAGES LICENSE <br /> ................................................... ............""', <br /> Does any individual or entity identified in question 6,and applicable attachments, have any direct or indirect,beneficial or financial <br /> interest in any other license to sell alcoholic beverages? Yes 7 No If yes,list in table below.Attach additional pages,if <br /> necessary,utilizing the table format below. <br /> ........... ........... <br /> Name License Type License Name ..... Municipality <br /> .......... <br /> F. <br /> .............. <br /> ................ ............. ........ ....................... .................................. ....................... <br /> fff,............. . ................. .........-­............................................ ................................. ........ ........... <br /> 68. PREVIOUSLY HELD INTEREST IN AN ALCOHOLIC BEVERAGES LICENSE <br /> .................. ................ . ............................ ........ <br /> Has any individual or entity identified identified in question 6,and applicable attachments,ever held a direct or indirect,beneficial or <br /> financial interest in a license to sell alcoholic beverages,which is not presently held? Yes No <br /> If yes,list in table below.Attach additional pages,if necessary,utilizing the table format below. <br /> ........... ........ ................ <br /> Name License Type License Name Municipality <br /> ............... ................... ............ <br /> ................................................................................................................................ ....... ...................................... ................................................................................. ............. <br /> ......................................................................................... ............. <br /> ............... .................................................... <br /> 6C. DISCLOSURE OF LICENSE DISCIPLINARY ACTION <br /> ............................................................................ ....... <br /> Have any of the disclosed licenses listed in question 6A or 613 ever been suspended,revoked or cancelled? <br /> Yes [] No 0 If yes,list in table below.Attach additional pages,if necessary,utilizing the table format below. <br /> [Date of Action Name of License city Reason for suspension,revocation or cancellation <br /> ........................---1...................................................................... .......... ....................... <br /> ..................................................................... .......................... ................................................................. -—-------------------------- ---------...... ................................................ <br /> ................................................. <br /> ....... .................... ......................... <br /> .............. ........-.................. . ........................ .................................................. ....................... <br /> 9 <br />