EXHIBIT ACITY OF HOBOKEN PLANNING BOARD & BOARD OF ADJUSTMENT f% 94 Washington Street, Hoboken, NJ 07030 APPLICATION FOR DEVELOPMENT [lc PROPERTY INFORINATION: Fropeny ase: | 318 Madison Street sce [ge] [25 rome once| es oma aa resent Use Deseo Vacant commercial and residential property Have there been any previous, known applications involving these premises? [] Yes (NO if yes nature of appliation, date and determination: there adjacent propery in common ownership? [ves [f No _ Wen addres of propery ad descption fs presen ure: ‘Are there any restriction, covenants, easements association bylaws, exsting or proposed on the property? ‘Yes copies mustbe attached tothe application) [J No__] Proposed describe nature of agreement and stats below E APPLICANT HF ORMINTIORE [OWNER INFORMATIONS [Corporation] Partnership) Indhviduat GW Coperatiowtic Partnership] individual ame: [ BigMad LLC Name: [ = /Aderess! 39 Stratford Court ladies] 39 stratford Court panes —}**u) Lora | (oe —] fu] elo Phone:| 973-376-0909 __| Fex| 973-376-0903 ron | 973.376-0009 | *[g73.376-0003 _ | mat mat Lischkolnick@bmkclaw.com __] Lischkolnick@bmk-law.com __] heat uc ded i weCITY OF HOBOKEN PLANNING & ZONING BOARD OF ADJUSTMENT CONTRIBUTION DISCLOSURE STATEMENT Affidavit STATE OF NEW JERSEY ‘COUNTY OF HUDSON Being duly swom according to law upon his/her thei oath depose and ay: Michael anu KProperyyOwner Gi Developer DoRedeveloper 1] Professional ‘making application or providing representation and/or support for an application for cetan approvals to the Planning Board, Zoning Board of Adjustment oF City Council acting asthe Redevelopment Agency forthe City of Hoboken pursuant tothe New Jersey Local Redevelopment and Housing Law (NJS.A.40A:12A-1, et seq) in regard toa property located at: Siveet Address_318 Madison Street Blocks 48. Lott): _25. ‘do hereby disclose, pursuant tothe requirements of municipal ordinance DA-152 (effective September 1, 2004), as amended, the ‘name ofthe recipient, the date and amount of any contribution, loan, gift subscription, advance or transfer of money or other ‘thing of value, including any item of real property or personal property, tangible or intangible, but not including services ‘provided without compensation by indlviduals volunteering a port or all ofthe time on behalf of a candidate, committee of ‘organization, made to or on behalf of any candidate, candidate committe, joint candidates committee, political committee, continuing political committee or politcal party committee and any pledge, promise or other commitment or assumption of ‘ibity to make such transfer. The disclosure below ince all such contributions made during the time period measuring from ‘one (1) year prior to the last municipal election through the time of fling the application with or seeking approval from the Cty, | urther understand that continuing disclosure is required for such contibutions made fllowing the fling ofthe “Contribution Disclosure Statement” and during the pendency of the application and/or approval process and hereby agree that prior to _Fanting offal approval ofthe subject application, | will amend the disclosure statement if such Further contributions are made. ‘Sworn to and subscribed before me tis 04 ayer March. nolé. Page 102 required er submission)