New Jersey Administrative Code › Title 13 - LAW AND PUBLIC SAFETY › Chapter 69A - APPLICATIONS › Subchapter 5 - FORMS › Section 13:69A-5.8 - Business Entity Disclosure Form-Holding Company Casino Hotel Alcoholic Beverage Enterprise

Current through Register Vol. 56, No. 14, July 15, 2024
(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; and
iv. 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;
				and
13. 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; and
iii. Each
				natural person who indirectly holds any beneficial or ownership interest of 10
				percent or more of the applicant.