Current through Register Vol. 56, No. 21, November 4, 2024
Section 13:69A-5.8 - Business Entity Disclosure Form-Holding Company Casino Hotel Alcoholic Beverage Enterprise(a) A Casino Hotel Alcoholic Beverage Enterprise Business Entity Disclosure Form--Holding Company (CHAB BED-HC) shall be in a format prescribed by the Division and may require the applicant to provide the following information: 1. Any official or trade name used by the applicant for the last five years;2. The enterprise as to which the applicant has been identified as a holding company;3. The name, title, and telephone and fax numbers of a person to be contacted in reference to the application;4. The current or former business addresses, current mailing address, and telephone and fax numbers for the last five years of the applicant enterprise;5. The business form of the enterprise, and a copy of the certificate of incorporation, charter, bylaws, partnership agreement, trust agreement or other basic documentation of the enterprise;6. If the enterprise is a publicly traded corporation, the stock exchange its stock is traded on and its symbol;7. The name and location of any government agency in this State or any other jurisdiction that regulates the applicant, and the nature and extent of regulation;8. The Federal Employer Identification Number of the enterprise;9. During the last five-year period, whether the applicant has had any license or certificate denied, suspended or revoked by any government agency in this State or any other jurisdiction, the nature of such license or certificate, the agency and its location, the date of such action, the reasons therefor and the facts related thereto;10. The nature of the business of the enterprise;11. The following financial information:i. Two copies of the applicant's most recent audited or unaudited financial statement, auditor's report and Federal and state tax returns;ii. Within the last five-year period, information regarding any judgments or petitions for bankruptcy or insolvency and any relief sought under any provision of the Federal Bankruptcy Act or any state insolvency law; and any receiver, fiscal agent, trustee, reorganization trustee or similar officer appointed for the applicant's property or business;12. Within the last 10 years, civil, criminal, administrative and investigatory proceedings in this State or any jurisdiction, as follows:i. Information regarding any indictment, charge or conviction for any criminal or disorderly persons offense;ii. Any criminal proceeding in which the applicant has been a party or has been named as an unindicted co-conspirator;iii. Any judgment, order, consent decree or consent order entered against the applicant pertaining to a violation or alleged violation of the Federal antitrust, trade regulation or securities laws or similar laws of any jurisdiction; andiv. Any judgment, order, consent decree or consent order entered against the applicant pertaining to a violation or alleged violation of any other state or Federal statute, regulation or code which resulted in the imposition of a fine or penalty of $ 50,000 or more; and13. The name, home address, date of birth, title or position and percentage of ownership, where applicable, of each of the following persons or entities: i. Any officer, inside director, trustee, partner or sole proprietor;ii. Each enterprise or natural person that directly holds any beneficial or ownership interest of five percent or more of the holding company completing the application; andiii. Each natural person who indirectly holds any beneficial or ownership interest of 10 percent or more of the applicant.(b) In addition to the information in (a) above, a completed CHAB BED-HC may include the following: 1. A certification of truth, which shall be dated, notarized and signed by the following: i. If the applicant is a corporation, the president or any other authorized officer;ii. If the applicant is a partnership, each partner;iii. If the applicant is a limited partnership, each general partner;iv. If the applicant is a sole proprietorship, the sole proprietor; orv. If the applicant is any other business form, the president or any authorized officer;2. A Release Authorization directing all courts, probation departments, selective service boards, employers, educational institutions, banks, financial and other institutions and all governmental agencies, Federal, state and local, both foreign and domestic, to release any and all information pertaining to the applicant as requested by the Division, which shall be dated, notarized and signed by the following: i. If the applicant is a corporation, the president or any other authorized officer;ii. If the applicant is a partnership, a partner;iii. If the applicant is a limited partnership, a general partner;iv. If the applicant is a sole proprietorship, the sole proprietor; orv. If the applicant is any other business form, the president, or any authorized officer; and3. An acknowledgment of receipt of notice regarding confidentiality, consent to search and nonrefundability of filing fees, which shall be dated, notarized and signed in accordance with (b)2i through v above. N.J. Admin. Code § 13:69A-5.8