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ALCOHOLIC BEVERAGES CONTROL COMMISSION <br /> BENEFICIAL INTEREST CONTACT- Individual (continued) <br /> 7wnershipInterest If you hold a direct beneficial interest <br /> inition above,do you hold a direct Direct Q Indirect in the proposed licensee,please listerest in the proposed licensee? the%of interest you hold. <br /> If you hold an indirect beneficial interest in this license,please complete the Ownership/Interest Table below. <br /> Ownership/Interest <br /> If you hold an indirect interest in the proposed licensee,please list the organization(s)you hold a direct interest in which, in <br /> turn,hold a direct or indirect interest in the proposed licensee. These generally include parent companies,holding companies, <br /> trusts,etc. A Beneficial Interest-Organization Form will need to be completed for each entity listed below. <br /> Name of Beneficial Interest-Organization FEIN <br /> Other Beneficial Interest <br /> List any indirect or indirect beneficial or financial interest you have in any other Massachusetts Alcoholic Beverages <br /> dress ges License(s). <br /> T e of License License Number Premises Ad <br /> Name of License YP - <br /> ASS Group,Inc/Mashpee Mart §15;Off Premises 00068-PK-0670., : 44 Falmouth Road,Mashpee,MA 02 4 <br /> Familial Beneficial Interest <br /> Does any member of your immediate family have ownership interest in any other Massachusetts Alcoholic Beverages Licenses? <br /> Immediate family includes parents,siblings,spouse and spouses parents. Please list below. <br /> Relationship to You ABCC License Number Type of Interest(choose primary function) Per <br /> of Interest <br /> ffHave <br /> isciplinary Action <br /> ou ever been involved directly or indirectly in an alcoholic beverages license that was subject to disciplinary action? Ifease complete the following: <br /> Date of Action Name of License State City Reason for suspension,revocation or cancellation <br />