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i <br /> Rd <br /> .' <br /> 1 . If applicant will be leasing the premises to be licensed* state: <br /> a. _ ,:- *Beginning.date of lease �:;�'. Fading date of lease _ <br /> p9r 04 <br /> - %Tune. _ 199 May 3 1w 1 9 <br /> t r <br /> 11. a. Mate the names, addr4sse's, and-telephone numbers of all person,of entitie's who will have any direct or indirect - <br /> beneficial or financial Interest in this license, as required by Massachusetts General Law c. 138, S. I Sk <br /> NAME AOORESS TELEPHONE NUMBER <br /> Mountain "pillage Limited - 1 . .rowell Road. <br /> ' • <br /> Alexander - ---- C i arrnr7�nh.rwMAn. ,wrr..iwnr�rw wf <br /> # the - <br /> ­ . - o . e iui Mit �o ostas, r we a '- <br /> . 7 <br /> ted Partner West <br /> b. Describe all types of financial and beneficial interest each person or entity wil l have in this lleense: <br /> Beneficiaries of trust <br /> • +, - % •r.1 ? ! :� � . •_{ ..#� a ++ *.• , .. ..y - • <br /> 1 r - <br /> { R + } .* R • ••••rye. • � .14. a. Does any person or entity listed in question 13 have any direct or indirect beneficial or financial interest in any other <br /> an <br /> type of Iicense granted udder Mass. General Lava 138? MIe D o b. If yes, state for each son or entitSI M __- .�.__ ,.. ._.. TYPE OF LICENSE LI ENSE ADDRESS �esr <br /> ECRIPTI N O INTEREST <br /> - Ale a M' or as •Beer and .Wine 187 West Main street 50% Stockholders , o <br /> Hari 2 01 licen-se <br /> JEcaterini MiLtrokostas Beer and Wire 187 west Main Street stockholders of <br /> F <br /> Hyannis, MA 02601 license <br /> - rr - rw�-r'�rurw r�+�r�i��r�+•�urww•rrr �����r.i��nnrn�rrrwwr <br /> 15. a. HLa_s any person or entity named int_question 13 ever held a license under G.L.e. 138 which he she It does not presently ho id • <br /> Yes 1Vo b. If yes, state for each: <br /> } <br /> 14AME TYPE OF LICENSE !C NSE ACORESS DATE'LICENSE GRANTED <br /> T o start nos Mitrokostas Beer and Wire 1200 Maly street 19 8 7 <br /> 4 <br /> j <br /> Chatham, MA (sold in 1 8 <br /> ± <br /> 16. a. Has any person of entity named in question 13 ever had his/her/its license revoked or c ancelled? OYes No <br /> r <br /> . 1f fires, state for each name the date and reasons why the license was revoked or cancelled: <br /> 17. Has an person or entity named convicted.of a + <br /> �► p mad to question 1 ever been con vi sol ting any state or federal law. (elude m InDI' <br /> i <br /> traffic violations) -El Yes LE44o If fires, attach a statement of details, <br /> 18. If applicant is an individual, answer the following questions: <br /> a. Are you a United Mates Citizen? 11 Y es 0 No b. Are you at least twenty years old? Oyes ONo <br /> (I f yes provide a-copy+ of birth, nawaIi z abon or registered voter certificate) <br /> 19. If applicant is a partnership, answer the following questions: <br /> a. Are al l the partners United Mates Citizens? [:]ides No b,Are all of the partners at least twenty years old? Yes No <br /> (Provide copies of birth, naturalization or registered voter certificates for each partner) <br />