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Lauren Phillips
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1 MEDICAL MARIJUANA ESTABLISHMENT OWNERSHIP/APPLICANT DISCLOSURE FORM You may have submitted information regarding the ownership of the applicant for a medical marijuana application. However, Clark County Business License requires the disclosure of each individual owner of every business entity with an ownership interest in the applicant. Accordingly, please provide the requested information below to BLOutreaclz(ciJclarkcountynv.gov by 5 p.m. Wednesday, April30, Legal name of the proposed medical marijuana establishment (as filed with the Nevada Secretary of State): Waveseer of Nevada LLC Fictitious Firm Name (DBA, if applicable, as filed with the Clark County Clerk's Office): _N/A Control Number: D Disclosure of Ownership of Medical Marijuana Establishment: Business entities must list the names of all individual persons holding any ownership or financial interest for each business entity appearing before the Board or having an ownership interest in the Medical Marijuana Establishment. "Business entities" include all business associations organized under or governed by Title 7 of the Nevada Revised Statutes, including but not limited to private corporations, close corporations, foreign corporations, limited liability companies, partnerships, limited partnerships, and professional corporations. Publicly traded corporations shall list all Corporate Officers and Board of Directors in lieu of disclosing the names of individuals with ownership or financial interest. The disclosure requirement, as applied to land-use transactions, extends to the owner or operator and the landowner. Please use the attached form to provide the requested information. If a business entity is listed as an owner, please use a separate copy of the attached sheet to list all the individual owners of that business entity. Continue using additional copies of the attached sheet for each business entity listed until each individual person is disclosed for every business entity. I certify under penalty of perjury, that all of the information provided herein is current, complete and accurate. I also understand that the Board will not take any action on land-use approvals, contract approvals, land sales, leases or exchanges without the completed disclosure form. David Rosen Print Name 4/29/2014 Date

Accordingly, please provide the requested information below to BLOutreaclz(ciJclarkcountynv.gov by 5 p.m. Wednesday, April30, 2014.

2 Control Number: Dl Below is the list of owners in Full Name Address Title Percentage of Ownership Interest Waveseer, LLC 1248 West Altgeld St., Chicago, IL Member % Anna Cozy 1241 S Clayton, Denver, CO Member 1.037% William E. Shack, Jr 18 Highland Creek Dr., Henderson, NV Member 4.636% Jerald Spilsbury 2448 W Valley View Dr., Hurricane, UT Member % Flair Industries Trust 224 Bethwick Circle, Las Vegas, NV Member 4.636% Kevin Conway 1426 Clinton Pl., River Forest, IL Member 1.556% John Cooney 2238 N. Fremont, Chicago, IL Member 1.556% Frederick Licon 962 Tam O'Shanter, Las Vegas, NV Member 4.636% ' Raena O'Neill 9732 Falling Star Ave., Las Vegas, NV Member % ~ ~ Total% Ownership for Waveseer of Nevada, LLC 100% I

, Hurricane, UT Member 23.182% 84737 Flair Industries Trust 224 Bethwick Circle, Las Vegas, NV Member 4.636% 89123 Kevin Conway 1426 Clinton Pl., River Forest, IL 60305 Member 1.

3 Control Number: Below is a list of all individual owners of Flair Industries Trust, owner of (page 1 of 1) Full Name Address Title (Trust) Percentage of Ownership Interest of Trust Kevin Spilsbury 224 Bethwick Circle, Las Vegas, NV Sole Trustee 100%

Address Title (Trust) Percentage of Ownership Interest of Trust

4 Control Number: D 1 Full Name Address Title (Waveseer, Percentage of Ownership of LLC) Waveseer, LLC Bella Verona, LLC 352 Cumberland St., San Francisco, CA Member 0.254% Alan Butz 5920 Broadmeade Dr., Plano, TX Member 1.271% Deborah Canja 3520 Okemos Rd , Okemos, MI Member 0.127% Lionel Cant 904 N. East 4th St., Delray Beach, FL Member 0.635% Wendy Choslovsky 1947 N. Kenmore Ave, Chicago, IL Member 0.635% Kevin Conway 1426 Clinton Pl., River Forest, IL Member 0.635% John Cooney 2238 N. Fremont, Chicago, IL Member 0.635% My Eats, LLC 2280 Highland Village Rd., Suite 150, Member 0.635% Highland Village, TX William D. Davis Trust 3301 Karen Dr., Del way Beach, Fl Member 1.271% 4J Family Trust 6640 W. Patrick Lane, Las Vegas NV Member 0.635% BNC Medical 5621 Gillum Dr., Plano, TX Member 0.762% Investments, LLC

635% 33483 Wendy Choslovsky 1947 N. Kenmore Ave, Chicago, IL 60604 Member 0.635% Kevin Conway 1426 Clinton Pl., River Forest, IL 60305 Member 0.635% John Cooney 2238 N.

5 Control Number: Dl Below is a list of all individual owners of owner of (page 2 of3) Full Name Address Title Percentage of Ownership of Waveseer, LLC 2741 Brandywine St. NW, Washington, DC Member 0.127% Jason Gold Howard L. Gottlieb Trust 1560 Sherman Ave. #1020, Evanston, IL Member 1.271% Michael R. Kboudi 1515 Araphoe St. #1200, Denver, Co Member 0.127% Zing, LLC 4209 Pascal Place, Swansea, IL Member 2.033% Mia Park 2242 N. Cleveland, Chicago, IL Member 0.508% Sunil Puri First Rock Group, Inc., 6801 Spring Creek Member 1.271% Rd., Rockford, IL Marcia Rayman 47 W. 210 US Hwy 30, Big Rock, IL Member 1.017% William E. Shack, Jr. 18 Highland Creek Dr., Henderson, NV Member 2.541% Michael Teahan 279 Caravelle Dr., Jupiter, Fl Member 0.381% Victoria Thomas 1101 River Reach Drive #506, Ft. Member 0.635% Lauderdale, FL AAIOU1,LLC 618 W. Fulton, Chicago, IL Member 1.271%

#1200, Denver, Co 80202 Member 0.127% Zing, LLC 4209 Pascal Place, Swansea, IL 62226 Member 2.033% Mia Park 2242 N. Cleveland, Chicago, IL 60614 Member 0.508% Sunil Puri First Rock Group, Inc.

6 Control Number: D 1 Below is a list of all individual owners of Full Name Address Title Percentage of Ownership of Waveseer, LLC JEMM Industries, LLC 923 Saint Louis St, Edwardsville, IL Member % Marisol Enterprises 2, LLC Ridgefield Dr., Des Peres, MO Member % David Rosen 1116 W. George St., Chicago, IL Member % Menimo, LLC 797 Glenvista Place, Glendale, MO Member 2.440% Total% Ownership for Waveseer, LLC 100%

294% Marisol Enterprises 2, LLC 12510 Ridgefield Dr., Des Peres, MO 63131 Member 26.294% David Rosen 1116 W.

7 Control Number: Below is a list of all individual owners of owners (an owner ofwaveseer of Nevada) Full Name Address Title in Bella Verona, Percentage of LLC Ownership of Bella Verona, LLC Jeffrey Bonforte 352 Cumberland St., San Francisco, CA Member 50% Amy Bonforte 352 Cumberland St., San Francisco, CA Member 50% ; ~ ~

Bonforte 352 Cumberland St., San Francisco, CA 94114 Member 50% Amy Bonforte 352 Cumberland St.

8 --. Business Entity Name:_ Waveseer ofnevada Control Number: Below is a list of all individual owners of owners of (an owner of Waveseer of Nevada) Full Name Address Title in My Eats, LLC Percentage of Ownership of My Eats, LLC Greg Cyrier 2280 Highland Village Rd., Ste 150, Highland Sole Member 100% Village, TX ~ ~~ ~

Name Address Title in My Eats, LLC Percentage of Ownership of My Eats, LLC Greg

9 Business Entity Name:_ Waveseer ofnevada Contro!Numbcr: W14M22-D1083~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Below is a list of all individual owners of ~~~~~~;p~~~~~i~t(i*i\~~' owners of (an owner of Waveseer of Nevada) Full Name Address Title (Trust) Percentage of ' Ownership of Trust I William D. Davis 3301 Karen Dr., Delray Beach, FL Sole Trustee 100% I

$owners of ~~~~~~;p~~~~~i~t(i*i\~~' owners of (an owner of Waveseer of Nevada) Full Name$

10 ' Business Entity Name:_ Waveseer of Nevada Control Number: Dl Below is a list of all individual owners of 4J Family Trust, owners of (an owner of Waveseer of Nevada) Full Name Address Title (Trust) Percentage of Ownership of Trust Michael Dean 6640 W. Patrick Lane, Las Vegas, NV Trustee 50% Debora Dean 6640 W. Patrick Lane, Las Vegas, NV Trustee 50% ~ ~ -- ~ ~~-

Percentage of Ownership of Trust Michael Dean 6640 W.

11 Control Number: Below is a list of all individual owners of Nevada) owners of (an owner of Waveseer of Full Name Address Jacquelyn Delkus 5621 Gillum Dr., Plano, TX Title in BNC Medical Percentage of Ownership of Investments, LLC BNC Medical Investments, LLC Sole Member 100%

12 Control Number: Dl Below is a list of all individual owners of B.. ;owlitfc}ltr Gottlielf,'f~s..:t, owners of i ~~;111 ''J/',' c' ',>,,n.,,:'<'','/ ',1 ',;< (an owner of Waveseer of Nevada) Full Name Address Title (Trust) Percentage of Ownership of Trust Howard L. Gottlieb 1560 Sherman Ave., #1230, Evanston, IL Sole Trustee 100% ' -

,,:'<'','/ ',1 ',;< (an owner of Waveseer of Nevada) Full Name Address Title (Trust)

13 -~-----~ L Business Entity Name:_ Waveseer ofnevada Contro!Number: ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Below is a list of all individual owners of owners of (an owner ofwaveseer of Nevada) Full Name Address Title in Zing, LLC Percentage of Ownership of Zing, LLC Constance Kurowski 4209 Pascal Place, Swansea, IL Sole Member 100% ~----~ -~-...

owners of owners of (an owner ofwaveseer of Nevada) Full Name Address Title in Zing, LLC

14 Control Number: Dl Below is a list of all individual owners of~~tli~;uu(\1, owners of (an owner ofwaveseer of Nevada) Full Name Address Title in AAIOUl, LLC Percentage of Ownership of AAIOU, LLC Thaddeus Wong 618 W. Fulton, Chicago, IL Sole Member 100%

Full Name Address Title in AAIOUl, LLC Percentage of Ownership of

15 Control Number: Dl Below is a list of all individual owners of JEMM Industries, LLC, owners of (an owner ofwaveseer of Nevada) Full Name Address Title in JEMM, LLC Percentage of Ownership of JEMM, LLC Francesca Cooper 923 Saint Louis St, Edwardsville, IL Sole Member 100%

Address Title in JEMM, LLC Percentage of Ownership of JEMM, LLC Francesca

16 Control Number: DI Below is a list of all individual owners of owners of (an owner ofwaveseer of Nevada) Full Name Address Title in Marisol Percentage of Ownership of Enterprises 2, LLC Marisol Enterprises 2, LLC Jennefer Delkus Ridgefield Dr., Des Peres, MO Sole Member 100% L

Ownership of Enterprises 2, LLC Marisol Enterprises 2, LLC Jennefer Delkus 12510

17 Control Number: D 1 Below is a list of all individual owners of Me»inti:~'Iiti, owners (an,.,. '' c-, ~N ', owner of Waveseer of Nevada) Full Name Address Title in Menimo, LLC Percentage of Ownership of Menimo, LLC Scott Wanamaker 797 Glenvista Place, Glendale, MO Sole Member 100%

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